Sometimes the decision to see a migraine specialist is tricky. Your primary care physician or neurologist you see for your headaches may not think to refer you to one. Or you weren’t aware there were healthcare providers that specialize in migraines. 

Maybe you know about migraine specialists but aren't sure if you have the type of headaches they treat.

In this post, we pull together an overview of three significant categories of head pain, signs that your head pain may be neurological, and when to see a doctor. We also tell you when you should go to an emergency physician instead.

If you have been seeing a migraine specialist with no success, we also talk about what to consider when deciding to change migraine doctors.

Common Categories of Headaches

Most headaches severe enough you consider seeking medical treatment are from one of three common categories:

• Tension headaches - headaches with a slow onset with moderate or dull pain. Typically, the pain is on both sides of the head but might also hurt on the back of the head or the neck.
• Cluster headaches - headaches with sudden onset with pain on one side, often behind the eye. Several headaches occur in series or cluster, and the eyes may water and become red.
• Migraines - throbbing head pain that may be accompanied by nausea or vomiting. Sometimes you experience sensitivity to light. A migraine can last for several hours or days.

Tension headaches are thought to be caused by stress and muscle tension. However, genetics and the environment can play a role. You don’t typically experience nausea or vomiting, and the pain can come on slowly. However, you may experience chronic tension headaches, possibly every day.

Cluster headaches come on suddenly and severely, often behind one eye. They are the most severe of the three headache types but are the least common. The headaches tend to come in groups, daily or multiple times a day. They can last from one to three hours and recur the same way each time. Cluster headaches may be caused by alcohol or tobacco use, brights lights, heat, or foods with nitrates like bacon or lunch meat.

Migraines can cause intense, throbbing pain. Some sufferers have nausea or vomiting along with head pain. Loss of appetite and light sensitivity are also common during migraines. The tendency towards migraines can run in families. The pain may last several days and could be linked to a chemical imbalance in the brain.

Signs a Headache May Have a Neurological Cause

Most of the time, head pain doesn’t mean there is an underlying problem that requires medical treatment. But sometimes, a pattern occurs that tells you it may be time to see a specialist to rule out something more serious.

If you seem to be suffering more headaches than usual, or they are more severe than usual, it’s time to see a doctor. If they worsen or don’t improve with over the counter medicine, it’s time to see a doctor. If it keeps you from working, sleeping, or living normally, It’s time to see a doctor.

If your headaches distress you and you want to find treatment options to help you control them … you guessed it, it’s time to see a doctor.

Taking headache medication frequently. 

Taking these drugs can sometimes result in a rebound headache, making things worse. If you take over-the-counter medication to treat headaches five or more days a month, you should see a doctor. If the headaches become debilitating, you may need a migraine specialist.

Headaches disrupt your daily routine.

The headaches may not disable you, but they keep you from enjoying life or working effectively. However, if a headache immobilizes you every time you experience one, then a migraine specialist might be able to help.

Here’s a hint - if you have to lie down during the headache, you are disabled. See the migraine specialist.

Other symptoms occur.

Does your headache only occur on one side? Or do you get pain in specific areas? For these or other symptoms such as light and sound sensitivity, nausea and vomiting, or weakness or numbness anywhere in your body, see a neurologist or consult with your primary care physician with an eye toward a referral. 

If the neurologist or primary care physician cannot identify a cause, see a migraine specialist, even if your headaches don't match the description of a classic migraine. Your primary healthcare provider may steer you towards a migraine specialist first, depending on your symptoms and the type of headaches you describe.

When to Seek Emergency Care

Sometimes a headache signals something that should be diagnosed and treated immediately. You may be experiencing a stroke or developing meningitis or encephalitis.

Call 911 or the local emergency number if you are having the worst headache you have ever felt, a sudden and severe headache, or a headache with any of the following symptoms:

• High fever, greater than 102 to 104 degrees Fahrenheit
• Stiff neck
• Fainting 
• Confusion or trouble understanding speech
• Weakness, numbness, or paralysis on one side of your body
• Trouble seeing, walking, or speaking
• Nausea or vomiting not related to a hangover or a stomach problem

Consider that all of these symptoms are extremely serious, even if they are not accompanied by a headache. In all cases, you need to seek medical assistance immediately.

When to Change Migraine Specialists

Sometimes the doctor-patient relationship is a mismatch. Don't feel bad if you think you need to see other doctors. It's important to find a doctor that you trust and feel safe with.

When you seek medical treatment, you deserve to be heard and receive treatment for the problem you have, not one the doctor assumes. Sometimes the diagnosis is tough, and you need to seek a second or third opinion or even more. 

However, if you are sitting in the exam room and the following things happen, it can signal a losing relationship:

The doctor or staff dismisses your symptoms. 

They try to tell you that you just need to relax. But you are there because the migraines are causing you to miss work. Or you vomit every time an attack occurs. Your migraines are having a detrimental effect on your life, and you are being told to relax. 

If the doctor relentlessly downplays your symptoms, or worse, calls your migraines “headaches,” it’s time for a new migraine specialist.

Your first appointment is extremely short.

While a follow-up exam can take as little as 10 minutes, your initial consultation should take longer than that. You and the doctor need time to go over your symptoms, especially new ones, how you have been treating your migraine pain, and for the doctor to notice certain clues.

Your first visit should include a full exam as well. If you feel rushed, you won’t get the attention you need.

The doctor won’t listen.

Suffering migraines is a chronic condition. You and your migraine specialist should form a partnership. You both need to listen to each other. If you feel like the specialist is talking at you instead of listening to you, consider finding a different doctor.

Suffering frequent headaches that keep you from having a quality of life is not something to self-treat. Talk to your primary healthcare provider or contact a migraine specialist directly. Start doing something about that pain so you can be the best version of yourself.