When a headache is more than a headache

A few signs with a headache require an immediate call to 112, not booking an appointment. The first is a headache that comes on suddenly and peaks within seconds or minutes, like a blow, and is the worst you have ever had. The second is a headache with fever, a stiff neck, vomiting and sensitivity to light. The third is a headache with any neurological sign: sudden paralysis or numbness of the face, arm or leg on one side of the body, slurred speech or not understanding speech, sudden loss of vision, loss of balance or confusion. This also includes a headache after a blow to the head, especially with repeated vomiting or drowsiness, and a first epileptic seizure.

The reason for this strictness is simple. All of these can be conditions in which time matters: bleeding, inflammation of the membranes around the brain (meningitis) or a stroke. With a stroke every minute counts, and none of these conditions is treated in a clinic.

A second group of signs does not require 112 but deserves a quicker examination. A headache that appears for the first time after the age of fifty. A headache that is different from your previous ones, in character or in intensity. A headache that regularly wakes you at night or is worst in the morning and comes with vomiting. A headache that gets worse from week to week. A headache in someone with a weakened immune system or during cancer treatment. A headache with visual disturbances.

The most common trap for people with frequent headaches is not an illness but the treatment. Medication-overuse headache occurs when you take painkillers on more than ten to fifteen days a month. The medicine does ease the individual attack, but at the same time it keeps up a cycle from which the headache does not escape. Without a record this is easy to miss, because people almost always underestimate from memory how often they take them.

That is exactly why the most useful preparation for an appointment is a headache diary kept for a few weeks before the visit: date, duration, intensity, what you did that day, and which medicine you took and how much. This record often shows a pattern that conversation alone does not reveal.

Migraine typically affects one side of the head and comes with nausea and sensitivity to light or sound; in some people an aura comes before the attack. Tension-type headache is more even, like a band around the head, and less often stops the day. Cluster headaches come in periods, with very severe pain around one eye. Telling them apart is not an academic question, as it determines which treatment is even an option.

It makes sense to book with a neurologist when headaches are more frequent or stronger than before, when you take painkillers regularly, when the headache does not respond to treatment so far, or when you are worried because of illness in the family. Specialist care for headaches and cerebrovascular diseases is provided at the neurology clinic.

Treatment is self-pay, so you do not need a referral and can book yourself. Booking is managed by the provider that runs the clinic. Bring your headache diary, reports of previous tests, including any head or spine imaging, and a list of medicines with doses.