The diagnosis of a headache is done with a careful interview and the clinical examination. You might find painful muscular strings at the scalp, neck and shoulders, often with a slack body posture. The blood pressure might be out of range. Psychologically the patients seem tense, nervous, sorrowful. When assuming a tension headache it is malpractice not to have intensively spoken with the patient about possible major psychological distress. When assuming a psychogenic headache you must be able to formulate a positive psychiatric diagnosis (e.g. depression). Also a careful evaluation of the patient’s working conditions with his job, e.g. computer eyestrain, is necessary.
The routine blood tests are mostly normal. In vasomotor headache sometimes low iron values and perhaps a slight anemia can be found. In patients with signs of defatigation or vegetative dysregulation you might look for decreased magnesium, zinc and other rare elements. In these cases also an increased R–R interval in the ECG might occur.
The EEG might reveal an increased alertness with low amplitudes lacking alpha rhythm but with increased photosynchronisation in the higher frequencies Usually there are many muscular artifacts. Really pathological findings are rare.