When to see a neurologist for chronic headaches

Headaches are incredibly common. But we all know that not every headache feels the same. For many people, managing recurring headache pain becomes a part of daily life, and they may go on for years without realising that specialist care could make a huge difference.

If you have been struggling in silence, it can be difficult to know when to ask for more help. This article explains when your headaches should be assessed by a neurologist and what that process actually involves. So, you can feel more confident about your next steps.

What counts as a chronic or concerning headache

It is normal to experience an occasional headache due to stress or tiredness. However, there is a distinct difference between these occasional moments and chronic headache patterns.

When trying to identify the need to see a specialist, the frequency, duration, and severity of your pain matter significantly. It is not just about how much it hurts. But also, how often it disrupts your daily life. Additionally, headaches that change over time, like becoming more frequent or feeling different than usual, deserve medical attention.

Common types of headaches a neurologist evaluates

Neurologists are experts in diagnosing and treating various specific types of head pain. Some of the most common conditions they evaluate include:

• Migraines and chronic migraines: These are intense, often debilitating headaches that may come with other symptoms like nausea or light sensitivity.
• Tension-type headaches: Often described as a tight band around the head, these are very common but can become chronic.
• Cluster headaches and other trigeminal autonomic headaches: These are severe attacks of pain, often occurring in cycles or clusters, usually on one side of the head.
• Secondary headaches: These are headaches caused by an underlying condition, rather than the headache being the primary issue.

Red flag symptoms that need urgent assessment

While most headaches are unpleasant but not dangerous, there are certain signs that suggest you should seek medical advice more urgently. Doctors often refer to these as “red flags.”

Please seek immediate assessment if you experience:

• A sudden, severe headache that feels like the “worst-ever” pain you have experienced
• Headaches accompanied by weakness, confusion, difficulty speaking, or loss of vision
• New headaches developing after the age of 50
• Headaches occurring with a fever, a stiff neck, or unexplained weight loss
• Headaches that wake you from sleep or get worse when you cough or strain

When GP management may not be enough

Your General Practitioner (GP) is an excellent first port of call, but there are times when their management plan may no longer be enough to control your symptoms.

You might want to consider asking for a referral to a neurologist, if:

• Your headaches are not responding to standard treatments prescribed by your GP
• You find yourself with an increasing reliance on pain relief medications just to get through the day
• Your headaches are significantly affecting your work, sleep, or the ability to enjoy daily life
• You are making recurrent visits to the emergency department because you could no longer tolerate the pain or if it becomes unmanageable

What a neurologist looks for

Seeing a specialist can feel daunting, but their primary goal is to understand your specific situation. A neurologist will start by taking a detailed history (e.g., when the headache started) and tracking the patterns of your pain.

They will perform a neurological examination and review your symptoms to get a full picture of your health. A key part of this process is distinguishing between primary headaches (where the headache is the condition itself) and secondary headaches (where the headache is a symptom of something else).

Treatment options after specialist assessment

Once a diagnosis is made, a neurologist can offer a range of treatments that are personalised to your specific needs. These often go beyond simple painkillers and can include:

• Preventive strategies in the form of specific medications or lifestyle changes that are designed to stop headaches before they even start
• Acute treatments directed specifically to the type of headache you have to treat the attacks as they happen
• Non-drug approaches are options that treat pain without using any medication (e.g., nerve blocks or neuromodulators)

Importantly, a specialist will also help you understand the importance of avoiding medication overuse, which can happen if pain relief is used too frequently.

Conclusion

It is natural to worry when you are in pain, but it is important to remember that most chronic headaches are treatable with the right approach.

Seeking early input from a specialist can significantly improve your quality of life and reduce the long-term impact that chronic pain has on you and your family. Seeing a neurologist is about gaining clarity and finding a path forward. A specialist taking care of you is not about assuming the worst.

Find the best neurologists in the UK or search for the best specialists by location:

• Neurologists in London
• Neurologists in Manchester
• Neurologists in Birmingham
• Neurologists in Liverpool
• Neurologists in Harley Street

Medically Reviewed
Last reviewed on 17/01/2025