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Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines, and by monitoring how you respond to treatment. A complete physical exam will be done to make sure that your headaches are not due to muscle tension, sinus problems, or a more serious underlying brain disorder.

Tests are usually not needed if you have typical signs and symptoms of migraines. However, your doctor may order a brain MRI or CT scan to rule out other causes.

If you have a migraine with unusual symptoms such as weakness, memory problems, or loss of alertness, an EEG may be needed to rule out seizures. Rarely, a lumbar puncture (spinal tap) might be done.

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The following tests are commonly employed to determine if any underlying condition is causing thunderclap headaches.

CT scan

Diagnosis often starts with a CT scan of the head to search for an underlying cause for the headache. CT scans use an X-ray unit that rotates around your body and a computer to create cross-sectional images (like slices) of your brain and head.

Spinal tap

Sometimes a spinal tap (lumbar puncture) is needed as well. With this procedure, the doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The cerebrospinal fluid sample can be tested for protein, white blood cells and other substances.

MRI

In some cases, magnetic resonance imaging (MRI) may be done for further assessment. With this imaging study, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

Angiography

To obtain a picture of the blood vessels inside your head, your doctor may have you undergo a magnetic resonance angiogram or a CT angiogram, in which contrast material is injected intravenously during an MRI or CT scan.

When to seek medical advice?

Seek immediate medical attention for any headache that comes on suddenly and severely.

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Treatment for spinal headaches begins conservatively. Your doctor may recommend bed rest and oral pain relievers. If your headache hasn’t improved within 24 hours, your doctor may suggest one or more of the following treatments:

* Epidural blood patch. Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache.
* Intravenous caffeine. Delivered directly into your bloodstream, caffeine helps relieve spinal headaches — usually within a few hours — by constricting blood vessels within your head.
* Epidural saline. Injecting a saltwater solution into the space outside the membrane that covers your spinal cord may put pressure on the lumbar puncture site and stop the cerebrospinal fluid leak. But because saline solution is absorbed so quickly by the body, spinal headaches often recur after this treatment.

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Tell your doctor if you develop a headache after a spinal tap or spinal anesthesia — especially if the headache gets worse when you sit up or stand.

Spinal Headaches Screening and diagnosis

The doctor will ask questions about your headache and do a physical exam. Be sure to mention any recent procedures — particularly a spinal tap or spinal anesthesia.

Sometimes the doctor will recommend a magnetic resonance imagining (MRI) exam to exclude other causes of the headache. During the exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

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Spinal headaches are more common in women and in people who have a history of experiencing headaches in general. Spinal headaches occur most often in people between the ages of 20 and 40. The risk of spinal headaches increases with use of larger needles and multiple punctures in the membrane that surrounds the spinal cord.

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Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache.

Spinal headaches typically appear within 12 to 24 hours after a spinal tap or spinal anesthesia. Sometimes epidural anesthesia may lead to a spinal headache as well. Although epidural anesthesia is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is inadvertently punctured.

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Spinal headaches vary in intensity from mild to incapacitating. The pain typically gets worse when you sit up or stand and decreases or goes away when you lie down.

Spinal headaches are often accompanied by:

* Dizziness
* Ringing in the ears
* Nausea
* Visual changes

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Brain scans
Your doctor may recommend an MRI exam of the brain to detect any underlying causes for your headache. During the exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

In other cases, a CT scan of your brain may be done. CT employs an X-ray unit that rotates around your body and a computer to create cross-sectional images (like slices) of your brain and head.

Angiograms
Your doctor may also order a cerebral angiogram, a test that can visualize the neck and brain arteries. It involves threading thin tubing through a blood vessel, usually starting in the leg, to an artery in your neck. Contrast material is injected into the tubing to allow an X-ray machine to visualize the arteries in your neck and brain.

A less invasive version of this test uses MRI or CT, instead of threading a catheter through your blood vessels.

Spinal tap
Sometimes a spinal tap (lumbar puncture) is needed as well — especially if the headache appeared suddenly. With this procedure, the doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The fluid sample can be tested for evidence of bleeding or infection.

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