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 regularly, 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 (OTC) medication such as acetaminophen (Tylenol) or ibuprofen (Aleve), you may not need to seek further treatment, says Sandhya Kumar, MD, a neurologist and headache specialist at Wake Forest Baptist 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 7 out of 10 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 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 headaches, according to research. 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 may be 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 for several days. 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 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 your head, 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 Test This 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) scans 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 Tests These 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.