Doctors can sometimes identify the causes of a person’s headache with a physical exam. During the exam, they look for any signs of underlying conditions and explore the person’s history to establish whether the headaches follow any patterns.

Many people experience headaches from time to time. The National Institute of Neurological Disorders and Stroke (NINDS) explains that they vary in severity and frequency.

People usually get medical help when their headaches are so frequent and painful that they interfere with their daily activities.

Doctors describe headaches as pain in a person’s head or neck. Common types include tension headaches, migraine, and cluster headaches.

The NINDS explains that these are called primary headaches and do not indicate an underlying condition.

Some infections, seizures, tumors, or strokes, can cause headaches. These are called secondary headaches, and doctors will rule these out during a physical exam.

This article explains what happens during a physical exam for headaches. It explains what to expect and why doctors may ask about the person’s lifestyle and medical history.

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Doctors perform physical exams to help them work out why a person is experiencing headaches.

Part of this involves taking a detailed look at the person’s medical history and lifestyle to see whether there are any contributing factors.

Doctors use a physical exam to rule out underlying conditions or current infections that may link to a person’s headaches.

These include sinus infections, toothaches, and head injuries.

Doctors then look for patterns in a person’s headaches that may indicate whether they result from migraine, tension headaches, or cluster headaches. This helps them decide on the best course of treatment.

When performing a physical examination for headaches, a doctor will check a person’s vital signs, blood pressure, reflexes, and temperature. They will also check to see whether a person is calm or restless in a dark room.

They will also:

  • perform a neurologic examination to look for:
    • visual changes
    • weakness
    • tingling
    • challenges maintaining balance
  • check for tenderness or swelling of the:
    • scalp, as this could indicate injury
    • temporal artery
    • two joints that connect the lower part of the jaw to the skull
    • middle part of the throat behind the mouth
  • examine the eyes to check for symptoms such as:
    • changes in a person’s visual field
    • the size of the pupil
    • the eyes’ tear production and response to light
  • check for tooth pain
  • examine the neck to identify stiffness or discomfort, as this could indicate meningitis
  • examine the cervical spine for tenderness

Medical history and questions

Before the physical exam, doctors usually ask questions about the person’s general health and medical history.

The NINDS explains that this will include questions about any medications the person takes, prescribed or otherwise, and whether or not there is a family history of migraine or other types of headaches.

The NINDS recommends keeping a headache diary to help the person explain their symptoms and highlight any possible patterns or behaviors that lead to headaches.

They suggest noting:

  • the location of the headache and where the person feels the most pain
  • how severe the pain is
  • the type of pain — this may be throbbing, stabbing, or dull
  • whether or not the person experiences any sensitivity to light, smells, or sounds
  • what time of day it happens
  • how long the pain lasts
  • any changes in sleeping habits
  • whether or not the headaches coincide with a person’s menstrual cycle
  • potential food triggers or whether a person consumes alcohol or caffeine
  • sensations of nausea, vomiting, or dizziness
  • whether or not the person has performed strenuous exercise

Doctors may also ask how much screen time a person has each day, whether or not they take regular breaks from screens, and whether exercise, bowel movements, or coughing triggers the headaches.

If doctors suspect that a person’s headaches are because of an underlying condition, they may recommend additional tests, according to the NINDS.

The tests may include blood and urine tests to check for infections or toxins and neurological exams to check a person’s nervous system.

Occasionally, doctors recommend imaging tests, such as MRIs or CT scans, to look for:

Doctors can usually diagnose migraine, tension headaches, and cluster headaches during a physical exam and will recommend treatments depending on the type.

Doctors may recommend lifestyle changes for those with primary headaches. These may include keeping hydrated, eating a balanced diet regularly, and reducing stress or anxiety.

They may also prescribe medications for the different types of primary headaches.

If the doctor suspects the underlying cause of the headaches is another condition, such as a seizure disorder, stroke, or tumor, a person may need immediate and specialized care.

If the headaches are due to a treatable condition, such as an infection, doctors will start treatment as soon as possible. This may involve antibiotics, pain relief, and rest.

Many people contact a doctor about headaches when they interfere with their daily activities. But some headaches can indicate a serious health condition requiring immediate care.

The NINDS recommends getting urgent attention if a person has:

A person must also contact a doctor if they notice a change in the pattern of headaches they typically experience.

During a physical exam for headaches, doctors may ask the person about the type of pain they are experiencing and any additional symptoms, including sensitivity to light or fevers.

They will also discuss the person’s medical history and whether or not they have any family members with similar symptoms.

Doctors can usually identify primary headaches during a physical exam but may recommend further tests to check for underlying conditions.