When you need a specialist

When is a headache not “just a headache”? When is a headache more than a minor annoyance you can handle yourself, without consulting with your primary health care provider? And if you do ask for help, and the treatments suggested don’t work, when should you consider seeing a headache specialist?

Headaches can be the sign of other medical problems, and while this is rarely the case, only your health care provider can answer this question. While headaches are one of the most common health complaints in the United States, it may surprise you to know that less than half of all people with headaches ever seek medical treatment for them. This is not because having headaches is a trivial matter. In fact, headaches are one of the primary causes of missed work, and can affect all aspects of life.

Headache sufferers who think their headaches can’t be treated, or who try to diagnose and treat themselves, can get into trouble. It’s easy to develop the bad habit of overusing medications and develop medication overuse, or rebound headaches. By not talking with a doctor, there is increased risk of missing the opportunity to get the effective treatments that are only available from a health care professional.

When is it time to see a headache specialist?

It‘s important to work closely with your primary health care provider when you have headaches. Most people with headache can successfully learn ways to prevent them, or minimize their severity, by using the correct medications and other therapies. Good headache treatment starts with a medical evaluation that will probably include:

  • Gathering a personal and family medical history
  • A physical examination, including a neurological (brain and nervous system) assessment
  • A review of recent illnesses and injuries
  • A thorough review of your headache history, symptoms, and what treatments have worked
  • Maintaining a headache journal for several weeks to identify potential patterns and causes

If you have worked with your primary health care provider and consistently followed the suggested treatment plans, tried a number of treatments, and do not see improvement, it may be time for a referral to a headache specialist.

Who are headache specialists?

Most headache specialists are neurologists. Neurologists are physicians with advanced training in the diagnosis, treatment, and management of patients who suffer from neurological problems, which are problems affecting the brain and the central nervous system.
There can be many advantages to seeing a headache specialist. They have treated many people with problems like yours. They are more likely to have up-to-date knowledge about medical advances in headache treatments, and to have used and be comfortable with newer medications, and combinations of medications, that are not familiar to your primary care provider. A headache specialist has a broader knowledge of possible treatment choices, and is aware of the latest research findings. Many headache specialists work collaboratively with other professionals who can provide additional forms of treatment that are beneficial to people with headaches.

How do you find a headache specialist?

Begin your search for a specialist by asking your primary care provider for a referral. Good communication between your primary care provider and the specialist is important. Ask friends, family, or medical organizations for recommendations. The American Headache Society Committee on Headache Education website (www.ache.org) has a database to search for headache specialists by geographical area.
Headache specialist may work in a “multidisciplinary” headache clinic, in collaboration with other health care providers, in a practice with other neurologists, or in their own individual practice. Questions to keep in mind when considering the qualifications of a health care specialist are:

  • Is the specialist “board certified” by a medical organization that limits its membership to physicians who have specific training, and have passed tests in their specialty area?
  • Does the specialist participate in continuing medical education in order to stay aware of advances in the field?
  • Has the specialist written or taught others about their specialty area?

Summary

It is discouraging to try different treatments and still feel that your headaches are no better. If this happens after working closely with your primary care provider, and patiently waiting for each new treatment to work, this may be the time to consider seeking consultation with a headache specialist.

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References

American Headache Society (2008) Find a healthcare professional. Retrieved June 20, 2008 from http://www.achenet.org/

Robert, Teri (2005). Living Well With Migraine Disease and Headaches. New York: HarperCollins

Young, W. & Silberstein, S. (2004). Migraine and Other Headaches, New York, NY: AAN Press