Is It Time to See a Neurologist?

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 a regular basis, that may be a different story. Taking OTC headache medication 10 days or more out of the month can put you at risk of getting a rebound headache, a low-grade headache that’s caused by taking too much pain-relieving medication.

Signs You Need to Find a Neurologist

As a general rule, for non-severe headaches, your family doctor is a great place to start. However, if the recommended treatments are not working well or you have unusual symptoms, you may need a neurologist, who specializes in disorders of the nervous system.

Warning signs that you need specialized medical attention for your headache or migraine include:
You are over 50 and having chronic headaches or a new type of headache.
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.
You have two or more headaches in a week.
Your headaches are getting worse, not better, with time and treatment.
Your headaches are not responding to recommended OTC treatment or prescription drugs.
Your headache is sudden and severe and is accompanied by a stiff neck or fever.
You have a new headache and a history of cancer or HIV/AIDS.
Your headache begins after you hurt your head.
Your headache is making it hard for you to carry out your daily life.

Diagnosing Your Headache

According to headache expert Peter Goadsby, MD, director of the Headache Center at the University of California San Francisco, a valuable tool in diagnosis is your headache history. A thorough history, aided by your detailed notes, can help pinpoint causes, triggers, and even potential solutions. Make careful notes about your headache experiences before you go to the doctor and include:
When the headaches occur
What, if anything, makes them feel better or go away
Whether sound, light, or noise bothered you during the headache
Whether there were any changes in your vision before or during the headache, such as blurriness, black spots, or flashes of light
How well you slept the night before
If you are a woman, where you are in your menstrual cycle
Unusual weather at the time
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. However, if you are having severe or disabling headaches, don’t wait a full month to get checked out — make notes about what you recall and get the appointment you need.

Diagnostic Tests for Headache

The tests your doctor orders will depend in part on what she suspects could be causing your headaches and whether it’s a primary headache, such as a migraine, or a secondary headache, which means that it’s a symptom of another health concern. The process of diagnosis may include:
Medical history. Your doctor will want to know about other health conditions you have as well as medications, supplements, and herbal treatments or teas that you rely on.
Family history. You will provide details of any family members who have headaches or migraines, at what age the headaches started, and other health diagnoses. Goadsby notes, “Very often family members won’t know they’ve got migraines, but they will know they are prone to headaches.” This helps to indicate that migraine is the problem.
Physical exam. Your doctor will examine you, paying close attention to your head, neck, and shoulders, which can all contribute to headache pain.
Neurological exam. A neurological exam may include vision, hearing, nerves, reaction time, and mobility tests.
Blood tests. Blood tests may be ordered to help rule out infection and other health conditions of which headaches are 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 of which headaches are a symptom.
Imaging tests. Computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered. These imaging tests can show changes in bones and blood vessels as well as the presence of cysts and growths that may be causing your headaches.
Neuroimaging. Imaging tests may be given 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.

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