Headaches are something many people experience. If your headache symptoms are severe enough, your primary care doctor may refer you to a neurologist.
The neurodiagnostic services offered at Hendricks Regional Health assist physicians in diagnosing and treating neurological disorders and diseases.
Neurologists are medical specialists that focus on diagnosing and treating disorders of the nervous system. Some of the common conditions they treat include headaches or migraines, stroke, dementia, epilepsy, muscular dystrophy and Parkinson's disease. They help manage chronic pain, as well as carpal tunnel syndrome and sleep disorders.
In this segment, Joseph Herr, MD., joins the show to discuss at what point someone suffering from headaches should seek out a visit with a neurologist and what other roles a neurologist plays as part of your health care team.
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When Should You See a Neurologist for Headaches?
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Learn more about Joseph Herr, MD
Joseph Herr, MD
Joseph Herr, MD is certified by the American Society of Neuroimaging and is an acupuncturist. He is past Chief of Staff at Hendricks Regional Health.Learn more about Joseph Herr, MD
Transcription:
When Should You See a Neurologist for Headaches?
Melanie Cole (Host): Headaches are something we all experience. If your headache symptoms are severe enough, your primary care doctor may refer you to a neurologist. My guest today, is Dr. Joseph Herr. He’s a Neurologist with Hendricks Regional Health. Welcome to the show, Dr. Herr. Do we know the cause of some headaches? People get them -- migraines, they get sinus headaches. Do we know a general cause? What is a headache?
Dr. Joseph Herr (Guest): I think what I’d almost be more in is what causes people to not have headaches because having done neurology for 30 years, so many people that I run into – not only in the office but just in my regular, civilian life – have a lot of headaches. I hear from family members. I hear from neighbors and friends. Basically, what I can really attest to is the neurologist’s approach. I think an answer to your question -- first of all, the brain itself really is not a site that has pain, but there are a lot of protective mechanisms in the head. That is, protective mechanisms in the head and around the head that might be pushed a little far that may make for more headaches.
In my approach to a headache, first of all, I want to find out everything that I can about how often and what are we doing about them – about a headache, and what responses might be. But before the patient leaves, I really want them to be on the same page with the neurologist about – okay, what is it that the neurologist worries about? The neurologist didn’t order a scan or did order a scan. What’s the neurologist looking for? In that respect, there’s really two things that a person might expect seeing a neurologist about headaches. Number one, is the neurologist worried and going to investigate with testing? And B, if the neurologist isn’t worried, then how are we going to manage? We do a little bit of both.
The first question is who needs imaging? When is it reasonable to do a CT scan or an MRI scan of the brain? And generally, what seals the deal for me that we need that is if somebody has had a neurological change in addition to a headache, such as they’ve lost vision in an eye or have double vision, or they’ve been weak or numb on one side of the body. Or, maybe it’s even a more acute problem that somebody has decided they need to go to the Emergency Room because they have a bad headache and they have a fever. All of those things would necessitate somebody getting imaging. Also, if somebody has had headaches for years, and years, and years and nothing seems to work, it probably is a good idea to check imaging for refractory headaches, but I think the point here is that not everybody has to have imaging in order for us to not worry.
The second part, how does the neurologist manage this? Well, it depends a lot on – at least 90% of the headache patients that I see will be one or two patterns – one of two patterns. The first pattern will be intermittent, severe headaches that throb and make people nausea, and may make them nonproductive. Those are migraine category. Those are well-treated with medications that a lot of doctors have access and knowledge of and how to prescribe, so I don’t see a lot of that pattern.
Generally, what I see is chronic, daily headaches. That’s defined as having more than 15 days out of 30 of a headache for longer than six months. Generally, in those people, and also in people who have very frequent migraines, we’re going to try to tailor some kind of preventative treatment for them to use in addition to whatever abortive treatment that they take at the time of a headache. I think one of the most important things that neurologists end up explaining to patients about a headache is there is a problem that’s called rebound. That means that if you’re having a headache every day, Excedrin, or ibuprofen, or Tylenol, or Aleve, or variants of those taken every day aren’t going to handle the problem for very long before they become part of the problem.
Melanie: That was going to be my next question is as a lay person, when is it that we decide okay, I do have to go see a neurologist. I’ve been taking Aleve or Motrin, and this isn’t going away. I’ve tried hydrating. I’ve tried all of these home remedies, and it doesn’t seem to be going away. How long does somebody do that before they come to see you?
Dr. Herr: Realizing that the average wait time for the first appointment with a neurologist in the State of Indiana might be in terms of weeks rather than days, if a person says to themselves, “Well, it really doesn’t seem like what I’m doing is working. A, what I’m taking no longer is helping for a headache or what I am taking; I just have to start all over again tomorrow.” If what you’re doing doesn’t work for an individual headache or you’re finding that you have to treat more than three or four days every week for headaches, you need to see the neurologist about it.
Also, we are – we need to be more – headaches are super common. Nearly everybody has a headache once in a while. We need to be more concerned about the other symptoms. If you’ve got symptoms that your brain or your vision isn’t working right during a headache, or during a headache and after a headache, that’s probably the time to think about do I need to talk to my doctor? Do I need to go to the Emergency Room? Do I need a referral for a neurologist? I think it is – whatever is happening with headaches, it is a very reasonable thing to talk about with your primary care doctor and decide is it time for me to see a neurologist?
Melanie: People get headaches for all kinds of reasons, Dr. Herr, stress, and whatever, but then there are people who get migraine headaches. They experience this severe pain, and when they describe it, it really sounds awful. With somebody who does suffer migraines – and even kids get them now – what do you do for them? What kind of treatments are even available?
Dr. Herr: Well, the first thing that I do when I see a child that happens to have migraines is I ask that we pay attention to when they are occurring. What I see in children a lot is that once school is in session, the child comes home with a migraine on Monday. And general, it’s because of the sleep deprivation from sleeping late on Saturday and Sunday morning, going to bed early on Sunday, not being able to sleep, and then getting up very early, sleep deprived, Monday morning with a headache by the end of the day. Establish the pattern and realize that this guy out of my kids is not one that I’m going to let stay up very late on Fridays and Saturday nights because we miss school on Monday.
And then, if I don’t find something that way, the first thing that I will prescribe is to let them take two baby Aspirins and a Coke when this happens because the other most provocative trigger in a childhood headache is going to be we didn’t eat well that day. A little sugar on board, a little caffeine in the Coke, which will make the blood vessels that are perhaps dilated a bit in a migraine, squeeze a little tighter and not be so throbbing, that’s a good way for me to treat it.
From a migraine standpoint, we have a variety of agents that we use in adults for prevention that you take every day to prevent a migraine, and a variety of agents that we might have people take for an acute headache, but realizing that there’s this thing called rebound, I really feel like abortive treatment only is only going to be good for that person who needs to treat five or six days of headaches a month or less. If we’re getting five or six or more per month, then it’s time to use some kind of medicine that’s preventative.
Melanie: What other roles does a neurologist play? What other conditions do you treat?
Dr. Herr: A neurologist is a medical specialist of the brain and the nervous system. That’s much like saying a cardiologist is a medical specialist in the cardiovascular system and the heart. He’s not going to do bypass surgery, but he is going to diagnose and treat problems with the heart. A neurologist diagnoses and treats problems that have to do with the nervous system, and that may be a headache. That may be Parkinson’s disease, stroke, Multiple Sclerosis, spinal cord problems, peripheral nerve issues like carpal tunnel syndrome and other pinched nerves.
A neurologist might specialize in some kind of pain management, or super specialize in movement disorders, mainly Parkinson’s disease, and others. We have neurologists around town that have a special interest in one problem or another that may see more of that problem than a general neurologist does. If you think to yourself, this could be a problem in my nervous system – in what my nerves are telling me, what my nerves are asking my muscles to do, what is happening with my sensation, what’s happening with my brain and my ability to think, and concentrate, and remember, those are all things a neurologist can evaluate.
Melanie: Wrap it up for us, Dr. Herr, with your best advice about headaches, when to see a neurologist, what you really tell people every day that come to you and say, “Oh, I get these headaches all the time, and they’re so uncomfortable.” What do you tell them all the time?
Dr. Herr: That Aspirins, Tylenols, Excedrins, and ibuprofens, if you’re taking them every day, it’s not working, and we have got to find something different for the management of that.
Melanie: Great advice. Thank you so much, Doctor, for being with us, today. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks so much, for listening.
When Should You See a Neurologist for Headaches?
Melanie Cole (Host): Headaches are something we all experience. If your headache symptoms are severe enough, your primary care doctor may refer you to a neurologist. My guest today, is Dr. Joseph Herr. He’s a Neurologist with Hendricks Regional Health. Welcome to the show, Dr. Herr. Do we know the cause of some headaches? People get them -- migraines, they get sinus headaches. Do we know a general cause? What is a headache?
Dr. Joseph Herr (Guest): I think what I’d almost be more in is what causes people to not have headaches because having done neurology for 30 years, so many people that I run into – not only in the office but just in my regular, civilian life – have a lot of headaches. I hear from family members. I hear from neighbors and friends. Basically, what I can really attest to is the neurologist’s approach. I think an answer to your question -- first of all, the brain itself really is not a site that has pain, but there are a lot of protective mechanisms in the head. That is, protective mechanisms in the head and around the head that might be pushed a little far that may make for more headaches.
In my approach to a headache, first of all, I want to find out everything that I can about how often and what are we doing about them – about a headache, and what responses might be. But before the patient leaves, I really want them to be on the same page with the neurologist about – okay, what is it that the neurologist worries about? The neurologist didn’t order a scan or did order a scan. What’s the neurologist looking for? In that respect, there’s really two things that a person might expect seeing a neurologist about headaches. Number one, is the neurologist worried and going to investigate with testing? And B, if the neurologist isn’t worried, then how are we going to manage? We do a little bit of both.
The first question is who needs imaging? When is it reasonable to do a CT scan or an MRI scan of the brain? And generally, what seals the deal for me that we need that is if somebody has had a neurological change in addition to a headache, such as they’ve lost vision in an eye or have double vision, or they’ve been weak or numb on one side of the body. Or, maybe it’s even a more acute problem that somebody has decided they need to go to the Emergency Room because they have a bad headache and they have a fever. All of those things would necessitate somebody getting imaging. Also, if somebody has had headaches for years, and years, and years and nothing seems to work, it probably is a good idea to check imaging for refractory headaches, but I think the point here is that not everybody has to have imaging in order for us to not worry.
The second part, how does the neurologist manage this? Well, it depends a lot on – at least 90% of the headache patients that I see will be one or two patterns – one of two patterns. The first pattern will be intermittent, severe headaches that throb and make people nausea, and may make them nonproductive. Those are migraine category. Those are well-treated with medications that a lot of doctors have access and knowledge of and how to prescribe, so I don’t see a lot of that pattern.
Generally, what I see is chronic, daily headaches. That’s defined as having more than 15 days out of 30 of a headache for longer than six months. Generally, in those people, and also in people who have very frequent migraines, we’re going to try to tailor some kind of preventative treatment for them to use in addition to whatever abortive treatment that they take at the time of a headache. I think one of the most important things that neurologists end up explaining to patients about a headache is there is a problem that’s called rebound. That means that if you’re having a headache every day, Excedrin, or ibuprofen, or Tylenol, or Aleve, or variants of those taken every day aren’t going to handle the problem for very long before they become part of the problem.
Melanie: That was going to be my next question is as a lay person, when is it that we decide okay, I do have to go see a neurologist. I’ve been taking Aleve or Motrin, and this isn’t going away. I’ve tried hydrating. I’ve tried all of these home remedies, and it doesn’t seem to be going away. How long does somebody do that before they come to see you?
Dr. Herr: Realizing that the average wait time for the first appointment with a neurologist in the State of Indiana might be in terms of weeks rather than days, if a person says to themselves, “Well, it really doesn’t seem like what I’m doing is working. A, what I’m taking no longer is helping for a headache or what I am taking; I just have to start all over again tomorrow.” If what you’re doing doesn’t work for an individual headache or you’re finding that you have to treat more than three or four days every week for headaches, you need to see the neurologist about it.
Also, we are – we need to be more – headaches are super common. Nearly everybody has a headache once in a while. We need to be more concerned about the other symptoms. If you’ve got symptoms that your brain or your vision isn’t working right during a headache, or during a headache and after a headache, that’s probably the time to think about do I need to talk to my doctor? Do I need to go to the Emergency Room? Do I need a referral for a neurologist? I think it is – whatever is happening with headaches, it is a very reasonable thing to talk about with your primary care doctor and decide is it time for me to see a neurologist?
Melanie: People get headaches for all kinds of reasons, Dr. Herr, stress, and whatever, but then there are people who get migraine headaches. They experience this severe pain, and when they describe it, it really sounds awful. With somebody who does suffer migraines – and even kids get them now – what do you do for them? What kind of treatments are even available?
Dr. Herr: Well, the first thing that I do when I see a child that happens to have migraines is I ask that we pay attention to when they are occurring. What I see in children a lot is that once school is in session, the child comes home with a migraine on Monday. And general, it’s because of the sleep deprivation from sleeping late on Saturday and Sunday morning, going to bed early on Sunday, not being able to sleep, and then getting up very early, sleep deprived, Monday morning with a headache by the end of the day. Establish the pattern and realize that this guy out of my kids is not one that I’m going to let stay up very late on Fridays and Saturday nights because we miss school on Monday.
And then, if I don’t find something that way, the first thing that I will prescribe is to let them take two baby Aspirins and a Coke when this happens because the other most provocative trigger in a childhood headache is going to be we didn’t eat well that day. A little sugar on board, a little caffeine in the Coke, which will make the blood vessels that are perhaps dilated a bit in a migraine, squeeze a little tighter and not be so throbbing, that’s a good way for me to treat it.
From a migraine standpoint, we have a variety of agents that we use in adults for prevention that you take every day to prevent a migraine, and a variety of agents that we might have people take for an acute headache, but realizing that there’s this thing called rebound, I really feel like abortive treatment only is only going to be good for that person who needs to treat five or six days of headaches a month or less. If we’re getting five or six or more per month, then it’s time to use some kind of medicine that’s preventative.
Melanie: What other roles does a neurologist play? What other conditions do you treat?
Dr. Herr: A neurologist is a medical specialist of the brain and the nervous system. That’s much like saying a cardiologist is a medical specialist in the cardiovascular system and the heart. He’s not going to do bypass surgery, but he is going to diagnose and treat problems with the heart. A neurologist diagnoses and treats problems that have to do with the nervous system, and that may be a headache. That may be Parkinson’s disease, stroke, Multiple Sclerosis, spinal cord problems, peripheral nerve issues like carpal tunnel syndrome and other pinched nerves.
A neurologist might specialize in some kind of pain management, or super specialize in movement disorders, mainly Parkinson’s disease, and others. We have neurologists around town that have a special interest in one problem or another that may see more of that problem than a general neurologist does. If you think to yourself, this could be a problem in my nervous system – in what my nerves are telling me, what my nerves are asking my muscles to do, what is happening with my sensation, what’s happening with my brain and my ability to think, and concentrate, and remember, those are all things a neurologist can evaluate.
Melanie: Wrap it up for us, Dr. Herr, with your best advice about headaches, when to see a neurologist, what you really tell people every day that come to you and say, “Oh, I get these headaches all the time, and they’re so uncomfortable.” What do you tell them all the time?
Dr. Herr: That Aspirins, Tylenols, Excedrins, and ibuprofens, if you’re taking them every day, it’s not working, and we have got to find something different for the management of that.
Melanie: Great advice. Thank you so much, Doctor, for being with us, today. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks so much, for listening.