Who is it evaluated for?
A structured evaluation may be helpful for individuals experiencing recurrent headache, sensitivity to light-sound, nausea, aura, frequent painkiller use, or impairment in daily functioning. If there are new and unfamiliar features, the evaluation is planned with higher priority.
How is it planned?
The headache pattern, triggers, neurological examination, medication use, and daily life impact are evaluated together. When necessary, imaging or additional tests are planned; acute attack treatment, preventive options, and lifestyle adjustments are selected specifically for the individual.
Key points
- The vast majority of headaches are primary headaches such as migraine or tension-type headache; however, some features require investigating an underlying alternative cause.
- A headache that starts suddenly and reaches its most severe level within minutes, a new neurological finding, fever, altered consciousness, or a marked change in character can be red flags.
- In typical migraine or tension-type headache and with a normal neurological examination, routine imaging solely for reassurance is often not necessary.
- Frequent use of painkillers may contribute over time to medication overuse headache.
How are headache types differentiated?
The duration of the headache, location, throbbing or pressing quality, increase with movement, nausea, light-sound sensitivity, and accompanying neurological symptoms guide the diagnosis. Migraine, tension-type headache, and cluster headache display different patterns.
Features suggestive of migraine
Throbbing pain that can be unilateral, worsening with movement, nausea, and light-sound sensitivity may be consistent with migraine. In some patients, aura can be seen before the headache or independently in the form of visual, sensory, or speech symptoms. New-onset atypical aura features may require additional evaluation.
Tension-type headache
A pain pattern that is more bilateral, tight-pressing in nature, mild-to-moderate in intensity, and not significantly aggravated by daily activity may be observed. Neck-muscle tension may be present; however, not every neck tension is the sole cause of a headache.
When is imaging necessary?
The NICE 2025 update and American Headache Society recommendations state that if typical primary headache features and a normal neurological examination are present, routine imaging is not necessary in most cases. In contrast, further evaluation becomes more important in circumstances such as a new neurological deficit, rapidly changing pattern, first or worst headache, trauma, immunosuppression, history of cancer, or a new headache triggered by position/exercise.
Medication overuse headache
Frequently used acute painkillers or migraine medications may contribute to the headache becoming chronic in some individuals. Tracking the number of medication days used within a month is therefore important. A headache diary can be helpful to observe frequency, triggers, medications used, and treatment response.
Treatment approach
Treatment varies according to the headache type. Acute attack treatments and preventive options exist for migraine; in tension-type headache, lifestyle, appropriate analgesic use, and certain preventive approaches can be evaluated. Sleep, meal routine, fluid intake, caffeine use, and stress management may affect the headache burden in some individuals.
Complementary methods
Magnesium, riboflavin, certain behavioral methods, and neuromodulation options may be considered supportive in specific headache groups. Data regarding bioresonance or other complementary practices vary from method to method; they should not replace standard neurological evaluation and effective treatments.
Our approach at our Bodrum clinic
In headache, we first differentiate the pattern and red flags. Instead of unnecessary imaging or numerous tests, we prefer to establish a stepwise plan based on accurate headache classification, medication use frequency, sleep, and triggers. For a detailed guide in cases of suspected migraine, the existing Migraine page can also be reviewed.
Related content
References
- NICE. Headaches in over 12s: diagnosis and management. CG150. Last updated 3 June 2025.
- American Headache Society. Neuroimaging for Migraine: Systematic Review and Evidence-Based Guideline. PMID: 31891197.
Written and medically reviewed by: Dr. Kerem Çağlayan
Last medical review: September 10, 2026
Warning: A new and severe headache may require emergency evaluation. This page does not replace an individual diagnosis.
