Diagnosis & Management of Headache & Migraine

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Accurate Diagnosis Comes First

Successful headache management begins with identifying the most likely headache disorder. This is primarily a clinical process based on the history, pattern of attacks, associated symptoms, examination findings and response to previous treatments.

Most headache disorders can be managed within primary care. However, specialist medical assessment may be appropriate when the diagnosis remains uncertain, symptoms are unusual or progressive, neurological signs are present, or standard treatments have been ineffective.

At The Health Equation, Gerry combines recognised headache classification with detailed clinical assessment to distinguish primary headache disorders from secondary causes and to identify the factors that may be influencing each patient’s symptoms.

The Value of a Headache Diary

A headache diary maintained for a minimum of eight weeks can provide valuable diagnostic information and establish a baseline against which treatment can be assessed.

Patients should record:

  • The date, duration and severity of each headache
  • Whether symptoms meet the pattern of migraine
  • Associated features such as nausea, aura, dizziness or sensory sensitivity
  • Medication taken, dosage and response
  • Possible triggers or relevant circumstances
  • The effect on work, exercise and everyday activity
  • Menstrual or hormonal timing where relevant
  • The number of headache days and migraine days each month

The diary can help distinguish episodic from chronic headache, identify medication overuse and reveal patterns that may otherwise be difficult to recall during a consultation. It should support clinical reasoning rather than become an exercise in trying to control or avoid every possible trigger.

This eight-week timeframe follows current NICE headache guidance.

Common Diagnostic Difficulties

Headache symptoms frequently overlap, and an initial diagnosis may not always explain the complete clinical pattern. Common areas of difficulty include:

  • Migraine being mistaken for “sinus headache”
  • Migraine-related neck pain being assumed to originate solely from the cervical spine
  • Tension-type headache and migraine occurring together
  • Medication-overuse headache obscuring the original headache disorder
  • Migraine aura being confused with a transient ischaemic attack or another neurological event
  • Facial or jaw pain overlapping with migraine, dental disorders or neuralgia

A first episode of unusual visual, sensory, speech or motor disturbance requires appropriate medical assessment. Diagnosis should not be based on one symptom in isolation, particularly when the headache pattern is new or has changed.

When Is Brain Imaging Appropriate?

Most people with a typical primary headache disorder and a normal neurological examination do not require brain imaging. Scanning is not routinely recommended solely for reassurance when the clinical presentation is consistent with migraine or tension-type headache.

MRI or CT may be considered when:

  • The headache begins suddenly and is extremely severe
  • There is an abnormal neurological examination
  • New neurological symptoms do not fit a typical migraine pattern
  • The headache is progressive or has changed significantly
  • Symptoms suggest altered pressure within the skull
  • Headache follows significant head trauma
  • There are systemic warning signs or relevant medical risk factors
  • The diagnosis remains uncertain after appropriate clinical assessment

The choice and urgency of imaging depend on the clinical circumstances. Incidental findings are relatively common and may lead to further investigation without explaining the headache; imaging should therefore be requested for a clear clinical reason.

This approach is consistent with NICE guidance on headache diagnosis and management.

Diagnostic Assessment at The Health Equation

Gerry Gajadharsingh DO, Osteopath and Diagnostic Consultant in Integrated Medicine, draws on approximately 40 years of clinical practice when assessing patients with persistent or complex headache symptoms.

The 60-minute Diagnostic Consultation may include:

  • Detailed review of the headache pattern, associated symptoms and chronology
  • Previous diagnoses, investigations and response to treatment
  • Medication and supplement review
  • Relevant family, hormonal, sleep, lifestyle and medical history
  • Neurological and cranial-nerve screening where appropriate
  • Cardiovascular and orthostatic assessment when clinically indicated
  • Examination of the neck, jaw, thorax and wider musculoskeletal system
  • Assessment of breathing behaviour using capnometry
  • HRV monitoring to explore cardiorespiratory and neural regulation
  • Consideration of blood tests, diagnostic imaging or specialist referral

The findings are interpreted through the Integrated Regulatory Systems Framework (IRSF), considering interactions between the respiratory, neural, circulatory, endocrine, immune and inflammatory, metabolic and musculoskeletal systems.

Not every patient requires every component of assessment. Testing is selected according to the history and clinical findings.

Learn more about Heart Rate Variability
Learn more about Breathwork

Blood Testing and Functional Blood Analysis

Blood tests are not required to diagnose a typical primary headache disorder. However, targeted testing may be appropriate when the history suggests that anaemia, inflammation, thyroid dysfunction, nutritional deficiency, altered glucose regulation, hormonal factors or another systemic problem could be contributing to symptoms.

Where blood testing is undertaken, results can be reviewed through Gerry’s Functional Blood Analysis (FBA) approach. This considers:

  • Whether values fall within the laboratory reference range
  • The relationship between multiple biomarkers
  • Changes compared with previous results
  • Functionally low or high-normal patterns that may warrant clinical attention
  • The relevance of findings to the patient’s symptoms, history and wider regulatory health

Functional interpretation does not replace conventional medical diagnosis or established laboratory thresholds. Its purpose is to identify clinically meaningful patterns, support appropriate discussion and guide proportionate next steps.

Functional Blood Analysis Specimen report

Developing a Personalised Management Plan

Following the Diagnostic Consultation, the patient receives a comprehensive written report, usually within two working days unless further information or investigation is awaited. With consent, the report can also be shared with a GP, neurologist or another healthcare professional.

Management is based on the diagnosis, symptom burden, clinical findings and the patient’s priorities. It may include:

  • Explanation of the headache disorder and factors affecting the individual threshold
  • Advice on acute and preventive medical treatment for discussion with the appropriate prescriber
  • Osteopathic treatment where musculoskeletal dysfunction is relevant
  • Breathing re-training and strategies to support neural regulation
  • Sleep, hydration, nutrition and exercise recommendations
  • Review of medication use and possible medication-overuse headache
  • Targeted supplementation where clinically justified
  • Further blood tests, imaging or other investigations
  • Referral to a GP, neurologist or another specialist when appropriate
  • Review appointments to assess progress and refine the plan

Recommendations are made through shared decision making, with the benefits, limitations and alternatives explained wherever possible.

Multimodal Migraine Management

Effective migraine care often combines several complementary elements rather than relying on a single intervention.

These may include:

  • Appropriate treatment taken early during an acute attack
  • Preventive medication when attack frequency, severity or disability justifies it
  • Identification and management of medication overuse
  • Regular sleep, meals, hydration and physical activity
  • Management of relevant hormonal or medical factors
  • Behavioural approaches, relaxation or biofeedback
  • Neuromodulation devices where appropriate
  • Evidence-informed nutraceuticals or supplementation
  • Osteopathic and breathing-based interventions when clinically relevant

The decision to begin preventive treatment should not be based on a rigid number of migraine days alone. Frequency is important, but so are attack severity, duration, disability, response to acute medication, contraindications and patient preference.

Medical Treatments for Headache & Migraine

Book a Diagnostic Consultation

All new patients seeking assessment for recurrent, persistent or changing headache or migraine symptoms should book a 60-minute Diagnostic Consultation with Gerry Gajadharsingh DO.

This appointment provides time to review the full clinical history, previous investigations and treatment responses; undertake an appropriate examination; and determine whether additional testing, treatment or specialist referral is required.

Consultations are available in Harley Street, London, and Alton Barnes, near Marlborough in Wiltshire. Patients are encouraged to send relevant medical reports, imaging and blood-test results before attending. A comprehensive written report is included.

Could Your Symptoms Be Related to Migraine?

Migraine can produce a wide range of neurological, sensory, digestive and cognitive symptoms. Some people do not initially recognise their episodes as migraine, particularly when dizziness, visual disturbance, nausea, neck discomfort or sensory sensitivity is more prominent than head pain.

The image below, produced by the Association of Migraine Disorders, illustrates symptoms that may occur as part of the migraine spectrum. It is intended for general education and cannot establish a diagnosis; new, unusual or changing neurological symptoms require appropriate clinical assessment.

Symptoms that may be associated with migraine – Association of Migraine Disorders

Continue Exploring Headache and Migraine

Our supporting pages provide further information about headache and migraine: