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Call your health care provider if

Take the following symptoms seriously. If you cannot see your health care provider immediately, go to the emergency room or call 911:

Your headache comes on suddenly and is explosive or violent.
You would describe your headache as "your worst ever", even if you are prone to headaches.
Your headache is associated with slurred speech, change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss.
Your headache gets progressively worse over a 24-hour period.
Your headache is accompanied by fever, stiff neck, nausea, and vomiting.
Your headache occurs with a head injury.
Your headache is severe and localized to one eye with redness in that eye.
You are over age 50 and your headaches just began, especially with impaired vision and pain while chewing.

See your provider soon if:

Your headaches wake you up from sleep.
A headache lasts more than a few days.
Headaches are worse in the morning.
You have a history of headaches but they have changed in pattern or intensity.
You have headaches frequently, and there is no known cause.

What to expect at your health care provider's office

Your health care provider will obtain your medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.

The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your doctor may ask questions such as the following:

Is the headache located in the forehead, around the eyes, in the back of the head, near the temples, behind the eyeball, or all over?
Is the headache on one side only?
Is this a new type of headache for you?
Would you describe the headache as throbbing?
Is there a pressure or band-like sensation?
When does the headache occur? How long have you had headaches? How long does each headache last?
Does the headache awaken you from sleep? Are the headaches worse during the day and better at night?
Did other symptoms begin shortly after the headaches began? Do headaches occur repeatedly?
Does the headache reach maximum intensity over 1 to 2 hours?
Are the headaches worse when you are lying down? Standing up?
Are the headaches worse when you cough or strain?
Do they occur at a specific time related to your menstrual period?
What home treatment have you tried? How effective was it?

Diagnostic tests that may be performed include the following:

If a migraine is diagnosed, medications that contain ergot may be prescribed. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as is appropriate.

Prevention

The following healthy habits can lessen stress and reduce your chance of getting headaches:

Getting adequate sleep
Eating a healthy diet
Exercising regularly
Stretching your neck and upper body, especially if your work involves typing or using a computer
Learning proper posture
Quitting smoking
Learning to relax using meditation, deep breathing, yoga, or other techniques

References

Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. Classification of primary headaches. Neurology. August 10, 2004;63(3):427-35.

Snow V. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002; 137(10): 840-849.

Kaniecki RG. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology. 2002; 58(9 Suppl 6): S15-20.

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Reviewer Info: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.; ADAM Health Illustrated Encyclopedia, 05/16/2006