When a headache needs a neurologist

Most headaches settle on their own. A small number are telling you something else, and the difference is usually in the pattern rather than the pain.

The pattern matters more than the severity

A headache that arrives suddenly and reaches its worst inside a minute, one that wakes you from sleep, or one that changes character after years of being the same, is worth an appointment. So is a headache with new weakness, double vision, or a fever and a stiff neck.

What we do at the first appointment

We take a history, examine your eyes and your nervous system, and check your blood pressure. Imaging is not automatic: a scan answers a specific question, and we would rather ask the right one than photograph everything.

Living with migraine

For migraine the work is preventive. A headache diary for six weeks usually shows the triggers more clearly than any test, and it tells us whether a preventive medication is worth trying.