The average headache doesn’t require a call to a neurologist or even your family doctor. But if you're experiencing frequent headaches and using medication for them on the regular, that’s a different story.
If you have a history of headaches that come once or twice a month and go away when you take an over-the-counter medication such as acetaminophen or ibuprofen, you may not need to seek further treatment, says Sandhya Kumar, MD, a neurologist and headache specialist at Wake Forest Baptist Health in Winston-Salem, North Carolina.
“If you’re having headaches more than four times a month, especially if they are debilitating and keeping you home from work, you should see a provider for diagnosis and medication,” says Dr. Kumar.
Signs That You Should See a Neurologist for Your Headaches
As a general rule, for nonsevere headaches, your family doctor is a great person to start with. Approximately two out of three people talk to their primary care doctor first, according to the American Headache Society.
If the recommended treatments are not working well or you have unusual symptoms, your doctor may refer you to a neurologist, who specializes in disorders of the brain and nervous system.
Possible signs that you may need to see a specialist for your headaches include:
- You have two or more headaches per week. If your headaches come this frequently, you may need to add a preventive medication to your treatment plan.
- Your headaches are getting worse, not better, with time and treatment. This may signal you need further tests to make sure you’re properly diagnosed and on the right treatment.
- Your headaches are not responding to recommended OTC treatment or prescription drugs. Taking headache medication 10 days or more out of the month puts you at risk of developing medication-overuse headache (also called rebound headache) — hard-to-treat headaches that are caused by taking too much pain-relieving medication, says Dr. Kumar.
- You are over 50 and having chronic headaches or a new type of headache. Being older when you develop headache puts you in a higher risk category for certain types of secondary headache, according to a paper published inMayo Clinic Proceedingsin 2017. A secondary headache is one caused by an underlying disorder such as a stroke.
- You have a new headache and neurological symptoms such as weakness on one side of the body or a seizure. Symptoms such as these increase the risk that the headache has been caused by a brain tumor, according to Memorial Sloan Kettering Cancer Center.
- Your headache begins after you injure your head. This could indicate post-traumatic headache (PTH), which may require different treatments than other types of headache, according to the American Migraine Foundation.
- You have a new headache that lasts 24 hours a day, 7 days a week. This may be a sign of a secondary headache, according to the American Headache Society.
- Your headache is making it hard for you to carry out your daily life.If the pain is frequently keeping you from work or activities, you should check in with a doctor, says Kumar.
What to Tell Your Doctor About Your Headaches
According to the headache expert Peter Goadsby, MD, PhD, a professor of neurology at the UCLA Goldberg Migraine Program in Los Angeles, a valuable tool in diagnosis is your headache history.
A thorough history, aided by your detailed notes, can pinpoint causes, triggers, and even potential solutions. Make careful notes about your headache experiences before you go to the doctor. Include the following:
- When the headaches occur
- What, if anything, makes them feel better or go away
- Whether sound, light, or noise bother you during headaches
- Whether there are any changes in your vision before or during headaches, such as blurriness, black spots, or flashes of light
- How well you slept the night before your headache
- If you are a woman, when your headaches occur in relation to your menstrual cycle
- Any unusual weather at the time of your headaches
- Food or drink that you have consumed in the 24 hours before the headache
- Activities you were engaging in when the headache began or just prior to it
- Previous headache diagnoses and treatments you’ve tried
Dr. Goadsby recommends using a monthly calendar so that the pattern of headache days is clearly visible to you and your doctor.
If you are having severe or disabling headaches, don’t wait a full month to call for an appointment — make notes about what you recall or are experiencing and see a doctor as soon as you can.
Diagnostic Tests for Headache
The tests your doctor orders will depend in part on what they suspect could be causing your headaches and whether it’s a primary headache — such as a migraine or tension headache — or a secondary headache, which means that it’s a symptom of another health concern.
Although primary headaches can be painful and debilitating, they aren’t life-threatening.
Secondary headaches are much rarer and can be the sign of a serious health issue — sometimes even one that requires urgent medical attention.
The process of diagnosis may include the following:
Medical history Your doctor will want to know about any other health conditions you have as well as any medications, supplements, or herbal treatments you take.
Family history Be prepared to provide details about any family members who have headaches or migraine — at what age their headaches started, and any other health diagnoses they may have. As Goadsby notes, “Very often, family members won’t know they’ve got migraine, but they will know they are prone to headaches.” Since migraine has a strong genetic component, a family history of migraine-like symptoms is an indicator that your headaches are also being caused by migraine.
Physical exam Your doctor will examine you, paying close attention to yourhead, neck, and shoulders, which can all contribute to headache pain in various ways.
Neurological exam A neurological exam may include tests of your vision, hearing, short-term memory, reflexes, sensation, balance, and coordination.
Blood tests Blood tests may be ordered to rule out infection and other health conditions that have headache as a symptom.
Spinal fluid testThis may be necessary if your doctor suspects that your headaches are caused by certain types of infection or by bleeding in your brain.
Urinalysis A urine sample may be ordered to help rule out infection and other health conditions.
Imaging tests Computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered. These imaging tests can show structures in your head, neck, or elsewhere in the body that may be causing your headaches.
Neuroimaging Imaging tests may be done during a headache episode to get a clearer picture of what is going on during an actual headache.
Electroencephalogram (EEG) This test can show your doctor whether there are changes in brain wave activity. It can help diagnose brain tumors, seizures, head injury, and swelling in the brain.
Working closely with your family practitioner and a neurologist, if needed, will bring you closer to headache relief.
When to Seek Emergency Care for a Headache
Warning signs that you need immediate medical attention for your headache or migraine include:
- Your headache is accompanied by nausea, vomiting, dizziness, confusion, loss of consciousness, or blurry vision.
- Your headache is accompanied by weakness or loss of control of part of your body, speech, or vision. This could signal a stroke.
- Your headache is sudden and severe and is accompanied by a stiff neck or fever. This could be meningitis, an inflammation of the brain usually caused by a viral infection.
- Your headache is the “worst headache of your life.” The abrupt onset of a very severe headache could mean bleeding or a clot in the brain, according to the American Migraine Foundation.
RELATED: When Should You Worry About Your Headache and Seek Immediate Help?
Additional reporting by Becky Upham.
If you have severe headaches or accompanying symptoms that are disrupting your life, it might be a good idea to see a neurologist. Consider making an appointment with a neurologist if: Your headache is continuous for more than a day or two.What will a neurologist do about headaches? ›
A neurologist can help by doing a complete evaluation and ordering tests, if needed. They will work with you to determine the cause of your headaches and develop a treatment plan to help you find relief.Why would I be referred to a neurologist for headaches? ›
“Patients should see a neurologist for any headache that is disabling,” McLauchlin said. “This applies to you if you have to stop what you are doing and lie down during a headache.” If your headaches cause pain in other areas or if the pain is on only one side of the head, you may need to see a neurologist.What does a neurological headache feel like? ›
What does a migraine feel like? A migraine is a common neurological disease that causes a variety of symptoms, most notably a throbbing, pulsing headache on one side of your head. Your migraine will likely get worse with physical activity, lights, sounds or smells.How do you know if you need to see a neurologist? ›
See a neurologist if you experience the following, especially if you have a family history of neurological issues: Numbness or weakness that comes on suddenly or happens on one side of the body (if you think you are having a stroke, however, go to the emergency room or call 911 immediately)Why do I keep getting headaches everyday? ›
The causes of many chronic daily headaches aren't well-understood. True (primary) chronic daily headaches don't have an identifiable underlying cause. Conditions that might cause nonprimary chronic daily headaches include: Inflammation or other problems with the blood vessels in and around the brain, including stroke.What does an MRI of the brain show for headaches? ›
In some migraine patients, an MRI may show white spots on the brain. These spots are called white matter hyperintensities (WMHs), which are lesions in the brain visualized by areas of increased brightness. They can vary in size and location in areas of the brain.What does a neurologist do on your first visit? ›
Your neurologist will probably do a series of tests to narrow down the root causes of your complaint. They'll ask you a few questions about your medical history and symptoms, so it's a good idea to write down any health information that might be relevant before your appointment.How many headaches a month is normal? ›
Headaches can often stop you from going about your day because of the pain it can cause. But as painful as they can be, women's health expert Kirtly Parker Jones, MD, says headaches are common—if they occur less than twice a week. If your headaches occur more than twice a week, that is not normal.What blood test is done for headaches? ›
Laboratory tests for patients with headache include a complete blood count (CBC), thyroid function, erythrocyte sedimentation rate (ESR), glucose levels, electrolyte and fluid balance, and kidney function such as blood urea nitrogen (BUN). Hypothyroidism or hyperthyroidism may be associated with headaches.
- Anxiety Disorder.
- Tension Headaches.
- Meniere's Disease.
- Post-Concussion Syndrome.
- Medication Overuse Headaches.
- Sinus Infections.
An MRI can't diagnose migraines, cluster, or tension headaches, but it can help doctors rule out other medical conditions that may cause your symptoms, such as: A brain tumor. An infection in your brain, called an abscess.How do I know if my headache is nerve related? ›
Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears.What are early signs of neurological problems? ›
- Persistent or sudden onset of a headache.
- A headache that changes or is different.
- Loss of feeling or tingling.
- Weakness or loss of muscle strength.
- Loss of sight or double vision.
- Memory loss.
- Impaired mental ability.
- Lack of coordination.
An electroencephalogram measures your brain waves. Your neurologist will put electrodes, which are small metal discs, on your scalp. This will help your doctor look at your brain activity to see if your pain is from a brain disorder, brain damage, brain dysfunction, or sleep issues.What can a neurologist rule out? ›
A neurologist is a medical doctor with specialized training in diagnosing, treating, and managing disorders of the brain and nervous system including, but not limited to, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), concussion, epilepsy, migraine, multiple sclerosis, Parkinson's disease, and stroke.Does the location of a headache mean anything? ›
Depending on where you feel pain, the headache location usually determines what kind of headache you have: Tension headache: Both sides of your head or a band around your head. Migraine headache or hormonal headache: One side of your head. Cluster headache: One side of your head, specifically in or around your eye.What tests are done for headaches? ›
- Erythrocyte sedimentation rate (ESR), a blood test that can detect inflammation.
- CT scan.
- Digital subtraction angiography, a minimally invasive test that uses X-ray and iodine contrast to produce picture of blood vessels in the brain.
Headache disorders are among the most common disorders of the nervous system. It has been estimated that almost half of the adult population have had a headache at least once within the last year.