When to see your doctor about headaches

Most of us have experienced a headache at some point in our lives. The occasional headache may be nothing to worry about, but when they are frequent and unmanageable, it may be time to call the doctor.

“It’s extremely common to experience a headache once in a while,” says Dr. Christine Lay, headache specialist and director of the Centre for Headache at Women’s College Hospital.

“However, what’s not normal is to have recurrent, episodic headache that seems to come every week or every month – often with your menstrual cycle – and becomes difficult to manage,” Dr. Lay says. “That’s not something we want people accepting as normal.”

The most common type of headache is a tension-type headache.

“We no longer use the term ‘tension headache’ because it implies the person is tense or under stress or perhaps not managing things as well as they could,” Dr. Lay says. Tension-type headaches are usually fairly mild and manageable, usually with no associated light or sound intolerance or feeling sick, so they generally don’t require a doctor’s attention.

Migraine is the most common headache that brings a sufferer to the doctor for help. However, 50% of sufferers remain undiagnosed or misdiagnosed. In North America, the most common misdiagnosis for migraine is tension-type headache or sinus headache. Many migraine patients have weather-triggered headaches and sometimes they have a runny nose with it, so it gets blamed on sinus headache. You don’t have to have symptoms such as strictly one-sided headaches, vomiting or an aura (a visual or sensory disturbance that may accompany a headache) to be experiencing migraine.

Migraine headaches are usually moderate to severe and make it difficult for people to carry out routine activities. They are usually associated with sensitivity to light or sound, and with nausea, often resulting in a sufferer seeking rest in a dark quiet place.

Dr. Lay identifies several headache scenarios that should prompt a trip to the doctor:

• a worst-ever headache, or brand new headaches in someone who never had headaches before
• recurrent headaches
• headaches that are becoming difficult to manage
• headaches relieved by over-the-counter medication, but you feel like you’re taking a lot of it

The majority of people seeking help for headaches are those who are having a headache several times a month, they’re taking over-the-counter medicine but not getting the best relief, and the headache is becoming more disabling or starting to interfere with their ability to function, Dr. Lay says.

Your family doctor is a good place to start for headache treatment.

“If you have a family doctor who has understanding of migraine and the appropriate treatments then you’re in good hands,” Dr. Lay says. But if your family doctor is unable to help, you may need to ask for an evaluation with a neurologist or a headache specialist.

You can help both yourself and your doctor by being a well-educated patient. That means you can provide your doctor with the information she may need to treat you:

• a calendar of your headaches for the last three months
• medications you’re taking or have tried in the past, and how effective they are
• any identifiable triggers, such as weather or hormone fluctuations

The calendar you provide should show when you had a headache, how long the headaches last, and when you had your period so you can see whether there’s any association with your menstrual cycle. 

“It’s really looking at how often you’re having a headache and how debilitating that headache is,” Dr. Lay says, adding that studies have shown that at 80 per cent of migraine patients say they can’t function very well when they have a migraine, and 50 per cent say they have a significant degree of disability, leading to decreased work or school productivity.

“Migraine associated disability just keeps getting worse if migraine is undiagnosed or despite a diagnosis it is not effectively treated. It takes over a sufferer’s life.”

Don’t just list your medications: include the dosage you’ve been taking, how often you take it and whether it’s effective.

Finally, Dr. Lay advises patients to make a specific appointment with their doctor to talk about headache – don’t try to make it part of your annual checkup or another appointment.

“Because you really need a dedicated amount of time to talk about it and get a sense of what’s going on in order to develop a plan of management,” she says.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Nov. 9, 2016