Migraine and headaches: when should I see a neurologist?
Most headaches can be managed with your GP. Here's when a neurologist helps, and which headaches need urgent care.
Headaches are very common, and most are not caused by anything dangerous. The two most common types are tension-type headache, a dull band-like pressure, and migraine.
Migraine is more than a bad headache. It often causes a throbbing pain, usually on one side, along with nausea and sensitivity to light or sound. Some people get an aura beforehand, such as flashing lights or zigzag lines in their vision. Attacks can last hours to a few days and can make it hard to work or look after family.
Starting with your GP
Your GP is the right first stop. They'll ask about your pattern of headaches, check your blood pressure and do a short neurological examination. Most people don't need a brain scan.
It helps to keep a headache diary for a few weeks. Note:
- When each headache started and how long it lasted
- What the pain felt like and any other symptoms
- What medicine you took and whether it helped
- Possible triggers such as sleep, stress, meals, alcohol or your menstrual cycle
Using pain relief on many days each month can itself cause more frequent headaches, called medication overuse headache. Your GP can help you plan treatment that avoids this. Don't change or stop prescribed medicines without talking to them first.
When a neurologist can help
Your GP may refer you to Neurology if:
- Migraines are frequent or disabling despite treatment
- Several preventive treatments haven't worked or caused side effects
- The diagnosis is unclear, or the headache pattern has changed
- You may be suitable for newer migraine treatments that need specialist input
A neurologist will review your history and diary, may order tests, and will suggest acute and preventive options. Other professionals can help too, for example Psychology for stress and pain coping skills, or Physiotherapy if neck problems contribute.
You need a GP referral to claim a Medicare rebate for a neurologist. Fees vary, so ask before you book. Spec Book shows which neurologists have the soonest appointments, and your GP can send the referral with the booking.
When to get urgent help
Call 000 or go to an emergency department for:
- A sudden, severe headache that peaks within a minute, often described as the worst ever
- Headache with weakness, numbness, slurred speech, confusion or a drooping face
- Headache with fever, a stiff neck or a rash
- Headache after a head injury
- A new headache with seizures or loss of consciousness
Common questions
Do I need a scan for my migraines?
Most people with a typical migraine pattern don't. Your doctor will suggest a scan if there are warning signs or the pattern is unusual.
Can migraines be prevented?
Often, yes. Lifestyle changes and preventive treatments can reduce how often attacks happen. Your GP or neurologist can talk you through options.
Is migraine linked to hormones?
For some women, migraines are linked to their period, pregnancy or menopause. Mention this to your doctor, as it can guide treatment.
Can I see a neurologist by telehealth?
Follow-up visits often work well by telehealth. A first visit may need to be in person for an examination. See Is a telehealth appointment right for me?.
General information only, not medical advice. Everyone's situation is different, so check with your GP or the provider. In an emergency call 000.