The Neurological Examination:
As in other neurological disorders, a complete neurological examination is the starting point for diagnosing headache disorders. During the neurological examination, the patient may be asked to perform certain tasks that evaluate a specific part of the brain or spinal cord. Also, reflexes and strength are tested in different ways. After this initial examination, the neurologist typically has a certain diagnosis in mind and further diagnostic testing can be ordered if needed.

Magnetic Resonance Imaging (MRI):
For most patients with headaches, the diagnosis is straight forward and diagnostic testing other than the neurological examination is not required. However, if abnormalities such as tumor or stroke are suspected, an MRI may be ordered. MRI is a method of capturing high-resolution pictures of the brain. During an MRI, the patients lay in a large tube while magnetic fields are used to capture information about the brain. A powerful computer translates the information into images that are so detailed that the modern MRI has been compared to direct viewing of the brain (like that seen during autopsy). MRI can be crucial in diagnosing disorders of the brain (such as stroke) that can lead to imbalance.

Computed Tomography (CT) Scan:
Like the MRI, the CT scan provides pictures of the brain. Rather than magnetic fields, X rays are used to construct the images. Although the resolution of the images is higher with MRI, CT is more sensitive for detecting bleeding. For this reason, CT imaging is the test of choice if a brain hemorrhage is expected.

Lumbar Puncture (LP):
A lumbar puncture often referred to as a "spinal tap" is method of evaluation the spinal fluid that surrounds the brain and spinal cord. During the procedure, a needle is inserted into the lower part of the spine and fluid is removed for analysis. The spinal fluid pressure also can be measured. In the case of headache, a lumbar puncture can be helpful in ruling out bleeding (i.e., subarachnoid hemorrhage) or infections (i.e., meningitis). Also a condition called "pseudotumor cerebri" causes headaches from increased spinal fluid pressure and this condition is both diagnosed and treated with an LP.

Cerebral Angiography:
Cerebral angiography is a method for taking pictures of the blood vessels in the brain. There are two methods for brain angiography that are used most commonly: magnetic resonance angiography (MRA) and X ray (standard) angiography. MRA is performed much like MRI, except images are made of the blood vessels rather than brain tissue. During standard cerebral angiography, a tube or "catheter" is placed in an artery in the groin and then threaded through heart and into the arteries of the neck. A radio-opaque dye is then injected into the vessels and X ray images are made of the brain arteries. Standard angiography offers the highest image resolution, however, MRA is easier to perform and is noninvasive. Cerebral angiography is used most often to diagnose aneurysms.