Almost everyone gets headaches. Most are tension-type headaches or migraines that respond reasonably well to over-the-counter treatment and sensible habits. So the useful question is not “should I worry about a headache?” but “which headaches deserve a specialist opinion?”
Patterns that warrant a neurological opinion
Consider asking for a referral, or booking an evaluation directly, if any of the following apply:
- Frequency. You have headaches on 15 or more days a month, or you are using acute pain medication more than twice a week. Frequent use of painkillers can itself begin to drive headaches — a pattern called medication overuse headache.
- Change in character. A headache that feels distinctly different from your usual pattern, or that has changed in location, severity or timing.
- Failed treatment. Two or more preventive medications have been tried at adequate doses without benefit.
- Disruption. Headaches are causing you to miss work, school or family life despite treatment.
- Neurological symptoms. Weakness, numbness, difficulty speaking, double vision or persistent visual disturbance accompanying the headache.
Symptoms that need urgent attention
Some presentations should not wait for a routine appointment. Seek emergency care for a headache that comes on abruptly and reaches maximum intensity within seconds or a minute (“the worst headache of my life”), a headache with fever and a stiff neck, a headache following a head injury, or a headache with new confusion, seizure or loss of consciousness.
What an evaluation actually involves
A headache evaluation is largely a conversation. The history does most of the diagnostic work: how the pain started, where it sits, how long attacks last, what brings them on, what makes them better, and what you have already tried. This is followed by a neurological examination.
Imaging is not automatic. Scans are ordered when the history or examination suggests something that needs to be excluded — not as a routine step. A normal scan does not mean nothing is wrong, and an abnormal one does not always explain the pain.
How to make the appointment more useful
The single most helpful thing you can bring is a record of the last four to six weeks: which days you had headache, roughly how severe, what you took, and whether it helped. A note on your phone is enough. Patterns that are almost impossible to recall accurately in conversation become obvious on paper.
Also bring a complete list of medications and doses — including anything bought without a prescription — and the reports from any previous scans.
What treatment can look like
Treatment depends entirely on the diagnosis. Broadly, headache management separates into treating attacks when they happen and reducing how often they occur. For chronic migraine specifically, options may include preventive medication and, where established clinical criteria are met, Botox. For headaches arising from irritated nerves at the back of the head, a nerve block may be both a treatment and a way of confirming the source.
None of these is a default. Which applies to you depends on what the evaluation finds.