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The diagnosis of headache depends on the history. I identify the pattern of symptoms that enables a specific diagnosis to be made. Without the right diagnosis, the appropriate treatment cannot be given. An examination will take place to make sure that the nervous system is functioning normally. Attention is also given to the blood pressure.
Neck movement and whether it is tender is important as is the functioning of the jaw joints on either side. In many patients with migraine and tension headache, there is nothing to find. Some patients have a "furrowed brow" representing tension in the muscles of the forehead.
In some patients with headache, there is the need for a scan. Unless there is marked claustrophobia or specific reason not to do a magnetic resonance scan (MR/MRI), then this is the scan of choice. In the 21st century, it is just not acceptable to undertake an x-ray scan when investigating chronic headache particularly in young women.
Other tests that can be helpful include an assessment of the iron status as well as making sure there is no anaemia, thyroid function and the exclusion of diabetes.