Everyone gets a headache from time to time. But if you start to notice other symptoms along with your head pain, it may be a migraine. Your primary care doctor is probably your first appointment to help figure out what’s going on. They may refer you to a neurologist if they think your head pain could be from something more serious than just a regular headache.
Anyone at any age can have a migraine, even children. But they usually start in the teen years.
Tell your doctor if you have any other symptoms with your headaches like:
- Changes in your eyesight
- Pain worsened by straining
- Your headaches start suddenly
- Your pain lasts for more than a day
- Your headaches start early in the day
- Light sensitivity
If any of these symptoms disturb your daily schedule, you may need to make an appointment with a neurologist so they can check for migraines.
At Your Neurologist Exam
During your first appointment with your neurologist, they will ask about your medical history, your symptoms, and if any of your relatives have migraines.
After, they might do a physical exam or neurological tests to rule out other causes of your pain. Though the vast majority of headaches are not due to a serious health problem, your health care team will want to rule out possible causes like:
- Brain abscess (an infection of the brain)
- Hemorrhage (bleeding within the brain)
- Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
- Pseudotumor cerebri (increased intracranial pressure)
- Hydrocephalus (abnormal buildup of fluid in the brain)
- Infection of the brain such as meningitis or Lyme disease
- Encephalitis (inflammation and swelling of the brain)
- Blood clots
- Head trauma
- Sinus blockage or disease
- Blood vessel abnormalities
- Aneurysm (a bulge in the wall of a blood vessel that can leak or burst)
Your health care team will be on the lookout for telltale signs and symptoms like:
- Fever or abnormal breathing, pulse, or blood pressure
- Nausea, vomiting
- Changes in personality, inappropriate behavior
- Mental confusion
- Loss of consciousness
- Excessive fatigue, wanting to sleep all of the time
- Muscle weakness, numbness, or tingling
- Speech difficulties
- Balance problems, falling
Vision changes (blurry vision, double vision, blind spots)
Tests for Diagnosing Headaches
There are a few types of tests, and the one you get will depend on your symptoms:
MRI. If you’ve hurt your head recently, your neurologist might have you take an MRI to see if your headaches are caused by your injury. They may also use this test to check for structural issues or tumors.
CT scan. This can help your doctor figure out if your pain is from bleeding, spinal issues, or tumors in or near your head.
EEG. An electroencephalogram measures your brain waves. Your neurologist will put electrodes, which are small metal discs, on your scalp. This will help your doctor look at your brain activity to see if your pain is from a brain disorder, brain damage, brain dysfunction, or sleep issues.
Mental health. An interview with a psychologist is not a routine part of a headache evaluation, but it may be done to identify stress that triggers your headaches. You may be asked to complete a computerized questionnaire to provide in-depth information to the doctor.
Your neurologist might also perform eye exams, X-rays of your sinuses, a spinal tap, blood tests, or urine tests to check for various health disorders that could cause your headaches.
After evaluating the results of the headache history and physical, neurological, and psychological exams, your doctor should be able to tell the type of headache you have, whether it's serious, and whether more tests are needed.
How to Prepare for Your Appointment
Before your first neurology appointment, do these things to plan ahead:
Gather helpful information. You can organize your medical records or have them sent to your neurologist before your first appointment. Talk to your previous doctors so they can help you get copies of your documents.
You’ll also want to update your medical history. Make sure you can tell your neurologist about all your health conditions, medications (current and past ones, including those that needed a prescription and those that didn’t), supplements, surgeries, allergies, and your family’s history of head pain.
Be ready to talk about other lifestyle topics, like whether you smoke or drink, as well as your job. Openness can help your doctor better understand what you’re dealing with.
Explain your pain. You’ll need to describe your headache to your doctor. Be prepared to tell them what your headache feels like, where the pain is on your head, how long it lasts, when the issues happen, and if you know any possible triggers. You may want to keep a headache diary so that you can track these things. Bring it to your appointment for reference.
Bring questions. It can be hard to remember them, so write them down. Keep a list of things you want to ask your doctor. For instance:
- What could be the causes or triggers of my migraine?
- Will I need any tests?
- What are the best types of treatment for me? Do they have side effects?
- Are there alternative or complementary treatments I should consider?
- Can I make any changes to ease my pain?
- Is my pain temporary or permanent?
- How can I deal with migraines and my other health concerns?
- What websites or reading materials do you suggest?
If your neurologist finds that your pain is caused by migraines, they’ll recommend a treatment plan to stop your symptoms and help prevent them from coming back.
Doctors break up migraine medication into two main groups. You may use a drug to relieve your pain or medicine to prevent your pain.
Your migraine therapy depends on how often you get them, how bad they are, your symptoms, and your other medical conditions.
Your neurologist may also have advice about what to do, or not do, in your daily routine to help avoid your migraine triggers.