Headache
Headaches are one of the commonest problems experienced by human beings, with 9 in 10 reporting a problem in their lifetime and 4 in 5 bothered by headaches in any given year (Steiner et al. 2014, J Headache Pain). Headaches symptoms fall into patterns, based on their location, timing, and associated features. Although the significant majority of headaches are without a structural or worrying course, headaches understandably generate significant patient anxiety. A neurologist can help to apply their experience and expertise in considering the history of the headache and any examination findings in an individual patient’s context to arrive at a tailored management plan. The key to success is helping a patient understand their individual factors which predispose to their headache, and what strategies are most likely to be effective in reducing its burden.
Headaches without a significant or worrying cause are described in the medical literature as “primary”, whereas headaches caused by other disorders or diseases are “secondary”.
The commonest primary headache disorders are tension headache, and migraine.
Seeing a Neurologist
Common reasons why patients ask to see a neurologist about headaches include:
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a concern about a structural cause to the headache;
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a change in headache pattern;
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headache severity;
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additional neurological symptoms (e.g. droopy eyelid, altered sensation, weakness, or visual changes);
A common issue discussed in consultations is whether a head scan is needed (usually by magnetic resonance imaging, MRI). An effective consultation helps the patient consider the benefits and risks of a scan. The may potential benefit is reassurance through ruling out structural problems. An important risk, often overlooked by patients and clinicians, is incidental findings - which can contribute to anxiety.
Further Reading
For a further read, I recommend having a look at the Brain and Spine Foundation booklet on headache: https://www.brainandspine.org.uk/wp-content/uploads/2022/10/Headache.pdf