Many of us get headaches once in a while. They often go away on their own or with a couple of pain relievers. But some people get them often or for a long time or feel a lot of pain -- and nothing seems to work. If you’re one of them, it may be worthwhile to see a headache specialist.
Why a Specialist?
- Have headaches so bad that they interfere with your job, school, or family life
- Take aspirin, ibuprofen, acetaminophen, and other over-the-counter meds often
- Notice your headaches are getting worse
- Worry that you take too much medication
- Have gone to the ER because of your headache
- Had more than 15 headaches in the past month
Types of Experts
The only doctors who can legally call themselves headache specialists are those certified in headache medicine from the United Council for Neurologic Subspecialties. But this group is relatively small. Even without the certification, several types of doctors can have extra training in treating headaches. Some of them may have finished fellowships in headache medicine.
These are specialists who treat disorders of the brain and nervous system. They may even have further training in headaches and should be considered if headaches and migraines are severe or disabling or you're experiencing confusion or seizures.
Tests they may order include:
MRI. The scan can be used to get detailed images of the brain and its blood vessels. It would help show tumors, abnormalities, bleeding, infection and other brain or nervous system problems.
CT Scan. A CT scan will show cross sections of your brain which could help identify tumors, infections, injuries, bleeding or other issues which could be triggering the headaches.
EEG. An electroencephalogram will measure brain waves to see if they are functioning properly or are being disrupted.
They’re experts on disorders in the brain, nerves, and spinal cord. Headaches involve both your brain and your nervous system, so neurosurgeons may be consulted if headaches and migraines do not respond to medical treatment.
For one thing, neurosurgeons can do surgical procedures that your family doctor or internist can’t. You usually would have an operation only if medications have failed to help. Neurosurgeons can do:
Deep brain stimulation. Wires (electrodes) inserted inside your brain relay electrical pulses to target stubborn pain.
Peripheral nerve stimulation. Electrodes placed on your nerves or under your skin in the area where you’re in pain.
Ear, Nose, and Throat Doctors
If your headache is related to sinus issues, ENTs, aka otolaryngologists, may be worthwhile to consult. Some migraines can cause ringing in your ears or sinus pressure. A type of migraine called vestibular migraine can make you dizzy. This sort of vertigo can stem from problems in your inner ear.
An ENT doctor may help you find out the cause of your headaches.
Ophthalmologists may help with a serious condition called ocular migraines. About 1 in 4 people with migraine get auras, which can affect your vision. Another type, called retinal migraines, can leave you temporarily blinded. An eye doctor can help prevent damage to your vision and look for underlying issues.
Obstetricians and gynecologists focus on pregnancy, childbirth, and other women’s reproductive health issues. Women get migraines three times as often as men do. Sometimes, they can stem from changes in estrogen and other hormone levels during menstrual cycles or pregnancies.
For menstrual migraines, your doctor may prescribe a triptan, a class of drugs that prevent a migraine or stop one that’s already started. Other treatments are also available to treat or prevent menstrual migraines.
The pool of doctors with deep experience and expertise in migraines and headaches is far outsized by the number of people with severe cases. To help plug the shortage, the National Headache Foundation revived its program to recognize all types of clinicians for their abilities in treating the condition.
The foundation’s Certificate for Added Qualifications in Headache Medicine exam is given to MDs, DOs, (osteopathic doctors) and:
- Advanced nurse practitioners
- Physician assistants
- Clinical psychologists
How to Find a Specialist
Visit the American Migraine Foundation or the National Headache Foundation websites to search for a certified headache specialist near you. The Migraine Research Foundation lists headache specialists in every state.