When is a headache worth a doctor's visit?

Nearly everyone gets headaches, and the vast majority are tension-type or migraine — uncomfortable, but not dangerous. Still, a handful of patterns deserve a proper look.

The five patterns we never ignore

• Thunderclap onset — the worst headache of your life, peaking within a minute. This is an emergency: call 911.
• New headaches after 50, especially with jaw pain when chewing or scalp tenderness.
• Headache with neurological signs such as weakness, slurred speech, double vision or confusion.
• A steadily worsening pattern over weeks, or headaches that wake you from sleep.
• Headache with fever and a stiff neck.

What a first appointment looks like

We start by listening. Most diagnoses come from the history — when the pain started, where it sits, what makes it better or worse. A focused neurological exam follows; imaging is only needed in a minority of cases.

Keeping a two-week headache diary before your visit is the single most useful thing you can do. Note the time, the trigger you suspect and what you took for it.

Treatment is more than painkillers

Overusing pain relief can itself cause daily headaches. Sleep, hydration, caffeine timing and, for migraine, modern preventive medicines often make a far bigger difference.

If your headaches are getting in the way of work or family life, book a neurology consult or start with a video visit with one of our family physicians.