| When To Go To A Headache Doctor/Clinic by Dr. Patricia Mandalfino, MD, Waterloo, Ontario, Canada Headaches Associated with Worrisome Features Recall that headaches are classified into two main categories: primary headache disorders and secondary headaches. Primary headaches are those such as migraine, tension-type, cluster, and other less usual but benign headaches. These are lumped together because of their benign nature. They are not harbingers of a sinister process. In contrast, the secondary headaches are due to an underlying problem (hence the name "secondary"). The list of problems which may be present is long and includes diseases of blood vessels, tumors, infection, inflammation, trauma and general medical conditions (i.e. diabetes) as well as medication overuse. When a doctor sees a patient with a complaint of headache, he/she does a history, physical examination and possibly other tests such as x-ray, CT/MRI scans or blood work. This process sometimes reveals worrisome features and may prompt referral to a headache doctor or clinic. This would include: -headaches which are progressive -headaches associated with neurological deficits -headaches which present for the first time in mid-life or later -headache following trauma -headache in a person with known medical problems (i.e.high blood pressure, cancer, infection, blood disorders) -headache associated with fever and/or neck stiffness -headache which starts suddenly Many headaches with these worrisome features such as sudden onset, fever, rapid progression, will demand immediate medical attention and a referral may be made on an emergency basis to a hospital-based specialist. Otherwise, if there are some features which are concerning but do not mandate an urgent referral, a headache doctor or clinic may (be) the source for an opinion. The primary care doctor will judge the urgency of the situation and make the decision. However, your doctor can only do that with appropriate information, so it is always important to keep him/her up to date on your symptoms, particularly if these are changing. Benign Headaches Refractory to Treatment This is by far the most common reason a patient is seen by a headache doctor or clinic. These will include mostly tension-type, migraine and cluster headaches. Medication-induced headache is also a common finding in headache clinics. This is a condition in which chronic overuse of analgesic (pain-killing) medications is actually the cause for the head pain. As time goes on, the headaches escalate and the person will use more pain-killers so the cycle continues. Most often the problem lies in incompletely managed tension-type or migraine headaches so that individuals begin over-medicating with readily available analgesics as a way to cope. These benign headaches may be called "benign" because they are not associated with underlying disease. However, the severity and frequency can be so intense as to have a malignant effect on quality of life. Unusual Headache Types Some headaches, while not associated with worrisome features, may have atypical features which do not allow them to be easily diagnosed and/or treated. These may include some rare but benign headache types. As well, atypical headaches or facial pain can sometimes be secondary to problems with eyes, sinuses, teeth, jaw or neck. A referral is often made to a headache doctor or clinic in these cases for definitive diagnosis and treatment. What Does a Headache Doctor/Clinic Offer? First, it is important to know that headache specialists come from a variety of backgrounds. They may be family doctors who have taken a particular interest in headache treatment or specialists such as Neurologists, Anesthetists or Physiatrists. Because of their interest and expertise, they may be able to offer confirmation of a diagnosis and a range of treatment options. A headache clinic usually consists of a doctor as well as allied help professionals such as nurses, psychologists, social workers, physiotherapists, etc. With their collective expertise, they may be able to offer counseling, relaxation therapy, massage, exercise programs, and possibly alternative treatments such as biofeedback. Persons with significant headache problems may benefit from a combination of medical and allied health professional support, and therefore a headache clinic may be the best choice for them. This is not to say that headache doctors that work independently would not use allied health professional skills but only that these may not be available in one setting as is usually the case in a headache clinic. As a Final Note... It is important to know that there are misperceptions about why patients are referred to headache clinics. Some of my patients have worried that this is a sign of "weakness", for example, that they have low pain tolerance. It must be kept in mind that headache disorders range from very mild, occasional headaches to frequent, severe and incapacitating headaches. Just because a co-worker says they have "migraine" does not mean that they suffer the same degree of frequency or pain. This leads to my final point, which is that not every headache sufferer needs to be seen by a specialist or clinic. Primary care doctors, such as family physicians, may be highly skilled in managing chronic headache conditions. If headaches are well controlled in the family doctor's hands, there may be no further advantage to a headache specialist or clinic referral. |
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Published on the Help For Headaches Web Site |