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    My Head Still Hurts

    What To Do When Headache Treatments Don't Work

    What Kind of Doctor Should I See?

    "People who seek medical care for headaches should start with their primary doctor," Lipton says. "The overwhelming majority of patients can be well managed in primary care settings. Most don't need neurologists or headache specialists."

    That's also the experience of Donald B. Penzien, PhD, director of the head pain center at the University of Mississippi Medical Center, Jackson.

    "You don't have to be a rocket scientist to diagnose and treat most headaches," Penzien tells WebMD. "But it's not always easy to tell what causes a headache. Your primary care doctor may not have the time or training to delve deeply into it."

    When headache treatment fails to stop pain, he says, it may be time to see a specialist.

    "I like to say every doctor treats headache patients. But very few specialize in headache," Penzien says. "There is a lot to know. If you believe you have a difficult problem, seek out someone who does headache medicine for a living. Your general practitioner, as good a doctor as he or she may be, might not understand."

    Lipton says it's time to see a specialist if your headache diagnosis isn't clear.

    "If you ask what kind of headache you have and your doctor doesn't know, see a specialist," he says. "And some doctors don't consider treating headache a priority. If your doctor says, 'Honey, don't worry, it's only a migraine,' go see a specialist. Another reason is if after some period of treatment, you are still experiencing significant pain and disability."

    What Can I Expect from a Headache Specialist?

    For many patients, proper care will mean finding the right headache treatment or correcting the dosage and schedule for treatments that haven't worked before. Much of the time, headache treatment means stopping medicines that are actually causing so-called "rebound" headaches.

    "Usually, when the patient says he or she has they have tried everything, they either have tried a small fraction of the therapeutic armamentarium, or they have a condition that's making things worse -- usually overusing medications," Lipton says. " Medicines taken to relieve pain can exacerbate headache. People who for years have headache, who take 10 different preventive medicines, haven't addressed rebounding. It's one of the most important headache triggers."

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