If you’re like most people, you get the occasional headache brought on by stress, eye strain or even missing your morning coffee.
But some people have extremely painful or frequent headaches, such as migraines, that interfere with daily life.
These can be worrisome, because sometimes headaches are signs of more serious medical problems, including stroke, brain tumors or infectious diseases, like meningitis.
Headaches can also be a sign of concussion, a type of traumatic brain injury.
So when is it time to make an appointment with your doctor? And when is a headache an emergency?
David Walker, MD, a neurologist at Rush, has some advice if you’re having concerning headaches.
When to see a doctor for a headache
Some people who have regular headaches avoid going to the doctor because they believe their headaches are normal.
“Often these ‘regular’ headaches are migraine in disguise,” Walker says. “People with migraine may assume that everyone's getting these debilitating headaches every now and again. But that's just not true.”
Some signs that your regular headaches may be migraine include the following:
- The headaches interfere with your daily life
- You have sensitivity to light or sound
- You have associated nausea or vomiting
- You have a blood relative who has migraine
- The headaches are triggered by storms
Other types of headaches, such as tension headaches or headaches from injury, can also cause problems and make your quality of life worse. Where the pain is happening and the type of pain you’re having can help you figure out if you need to get medical help.
You should see your doctor if you notice changes in your headaches, such as the location, type of pain, accompanying symptoms or any of the following:
- New onset headaches starting at or after the age of 50
- New onset severe headaches, the worst pain you’ve ever felt
- Prolonged, persistent or worsening headaches
- Frequent headaches happening daily or several times a week
- Headaches accompanied by nausea or light or sound sensitivity
- Recurring headaches following a head injury or physical trauma
- Headaches that interfere with your ability to function
- Frequent use of medications for headache control
“If headaches are impacting your life and becoming more frequent and more disabling, that would be a time to see a doctor because we have so many treatments available nowadays,” Walker says.
What type of doctor should you see for a headache?
There are several types of physicians and specialists who can treat headaches. If you haven’t tried any treatments before, Walker says your primary care physician can be a good place to start.
“Your primary care doctor can prescribe the classic migraine medications, like triptans, and some other first-line preventive treatments,” Walker says.
Your PCP can also refer you to a specialist for further care if you need it.
If these or other previous treatments aren’t providing enough relief, you may want to make an appointment with a neurologist who specializes in headaches.
“As headache specialists, we’re knowledgeable about all the new treatments and how to get them authorized,” Walker says. “We spend a lot more time diagnosing patients and reading between the lines of what other treatment areas we can address.”
Headache specialists can consult with other experts, like neurosurgeons and ear, nose and throat physicians, if you need further care.
Walker says you may want to make an appointment directly with a neurologist if your headaches are having a big impact on your quality of life. For example, if your headaches are very painful or affecting your ability to work, a headache specialist may be your best option.
When to go to the emergency room for a headache
In some cases, patients should not wait for headache treatment and should seek care right away.
Go to the emergency room immediately if you experience any of the following:
- The worst headache you’ve ever had
- Headaches that come on suddenly, without warning
- A severe migraine lasting more than three days
- A headache accompanied by fever, stiff neck, nausea, vomiting, confusion, loss of consciousness or any neurologic symptoms, such as dizziness, weakness, numbness, slurred speech or vision changes
A sudden, severe, extremely painful headache can be a sign of a very serious issue.
“We call it ‘worst headache of life,’” Walker says. “It’s a sudden onset, severe thunderclap headache that reaches maximum intensity in 60 seconds or less. It can indicate a subarachnoid hemorrhage, or brain bleed, or a cerebral vessel disorder like reversible cerebral vasoconstriction syndrome, or RCVS.”
Headaches that come with fever; nausea; or neurological symptoms, like numbness, dizziness or changes in your senses, can be signs of other concerning conditions, like brain tumors, stroke or meningitis.
Fortunately, less than 1 percent of all headaches indicate a life-threatening problem.
Are there any at-home headache treatments?
If you have occasional mild or moderate headaches, you may want to try over-the-counter medications, like acetaminophen or NSAIDs, such as ibuprofen or aspirin.
These options are most effective when they are taken as soon as symptoms appear.
“The earlier, the better,” Walker says. “If you wait, they just won’t be as effective, and you could end up taking more medication.”
But Walker also advises that taking over-the-counter medicines can be a slippery slope.
“There’s something called medication overuse headache, or medication overexposure headache,” he says. “If you use an as-needed medication more than three times a week, you could be at risk of developing these dull, daily headaches on top of other headaches, like migraine headaches.”
Overexposure to over-the-counter medications can also make other treatments less effective.
“Once you start ramping up the amount of over-the-counter medication you use, that could be a sign you should see a headache specialist,” Walker says.
Can you get treated for a headache via telehealth?
Headaches can make it difficult for you to leave home. A virtual appointment for treatment could be another option.
Rush offers telehealth headache services for many patients who live in Illinois. But you will need to come in person for an initial visit.
"That’s because there are some important parts of the exam that are necessary to do in person,” Walker says. “This includes checking for swelling in the back of the eye, called papilledema, because that could suggest there's a secondary headache disorder going on, like idiopathic intracranial hypertension. We also palpate the back of the head where the occipital nerves originate because patients can have occipital neuralgia, which we often see with migraine.”
If you’ve had your initial in-person visit and you’ve been diagnosed with a primary headache disorder, you can make follow-up visits via telehealth. Your specialist can prescribe medication during these virtual appointments.
If you need treatment for headaches, you can call Rush at (888) 352-7874 or learn more on our General Neurology Services page. And if you already have a headache diagnosis, you can learn more about making virtual follow-up appointments on our Rush Connect Virtual Urgent Care page.
