Diagnosis & Management of Headache & Migraine

The Importance of Accurate Diagnosis

Accurate diagnosis of headaches remains a challenge for many individuals. Most common headache types can be managed in primary care, but for specialist assessment, it is often advisable to see a neurologist, a GP with a special interest in headaches (GPwSI), or a clinician experienced in complex cases.

A headache diary—kept over at least 8 weeks—can be invaluable. Patients are encouraged to track:

  • Frequency, duration, and severity of headaches

  • Associated symptoms

  • Medications taken for relief

  • Potential triggers

  • Relationship to menstruation (where relevant)

Misdiagnosis is common. For example, research shows that many patients initially diagnosed with sinus headaches are later found to have migraines, highlighting the importance of awareness and specialist input.

Imaging in Headache & Migraine

Many patients worry about serious causes such as brain tumours, but in non-emergency situations, the risk of discovering significant pathology in patients with isolated headaches and a normal neurological exam is no higher than in people without headaches.

While imaging (MRI, CT, X-ray, ultrasound) may provide short-term reassurance, it also carries risks:

  • Incidental findings occur in 6–15% of patients, which may not require treatment but can increase anxiety or affect insurance premiums.

  • The benefit of reassurance often diminishes over time, especially in those with anxiety or depression.

Therefore, imaging should be carefully considered, weighing risks and benefits rather than being used solely for reassurance.

A Unique Diagnostic Approach at The Health Equation

At The Health Equation, Mr. Gerry Gajadharsingh DO applies a comprehensive diagnostic approach built on more than 38 years of clinical practice.

The Diagnostic Consultation (60 mins) includes:

  • Detailed history: symptoms, lifestyle, family, medications, psychology

  • Clinical examination: neuromusculoskeletal, neurological, cardiovascular, and respiratory systems

  • Specialist tools:

    • Capnometry to measure breathing behaviour

    • Heart Rate Variability (HRV) monitoring to assess autonomic nervous system balance

  • Consideration of additional tests: blood work, imaging, or functional assessments where appropriate

Many headache and migraine patients present with breathing pattern disorders and autonomic dysregulation, both of which are addressed in the evaluation.

Learn more about Heart Rate Variability
Learn more about Breathing Therapy

Functional Medical Perspective

Blood tests are not only assessed against standard medical ranges, but also analysed from a functional medicine perspective using narrower ranges for deeper insights. Patients receive a Functional Blood Analysis (FBA) reportexplaining key parameters, their significance, and recommended next steps.

Treatment & Management

Following a diagnostic consultation, patients receive a written report within 2 working days, which can also be shared with GPs or consultants (with consent).

Treatment plans may include:

  • Osteopathic Manual Treatment (OMT)

  • Breathing re-education & stress management

  • Dietary adjustments & nutritional supplementation

  • Techniques to improve autonomic nervous system balance

  • Appropriate exercise strategies

  • Referral to other specialists where necessary

Multimodal Migraine Management

Effective migraine management is usually multifaceted, in line with recommendations from the American Academy of Neurology and the American Headache Society. This may involve:

  • Abortive & preventive medications

  • Neuromodulation devices

  • Biobehavioural therapy

  • Nutraceuticals & supplements

  • Complementary & integrative modalities

  • Biofeedback techniques

Preventive treatment is especially important for patients with six or more migraine days per month, as per consensus guidelines.

✅ At The Health Equation, we combine advanced diagnostics, functional medicine, and osteopathic treatment to provide integrated care for headache and migraine patients in London and Marlborough.

Below is a slide from the Association of Migraine Disorders, which can help you decide whether your symptoms may well be related to migraine.