It depends on (1) severity of the headache, and (2) what diagnosis and treatment options you have tried in the past. When primary care providers deem the headache to be too severe for the diagnosis and treatment options they have available, they will typically refer you to a neurologist. Severe headaches are often accompanied by nausea, vomiting, dizziness, loss of consciousness and blurred vision. They can be deemed to be serious based on their high frequency of occurrence, or their traumatic cause. If your primary care provider has tried to treat you over an extended period without success, that can also trigger a neurologist referral, particularly if symptoms worsen. Your insurance plan may require you to see your primary care provider for a referral before visiting a neurologist. As specialists in the diagnosis and treatment of diseases of the brain and nervous system, neurologists are able to effectively diagnose and treat various types of headaches.
Neurologists mainly rely on self-reported symptoms, blood and urine tests, and diagnostic imaging (CT, MRI) to determine the cause of headaches. A necessary part of this process is ruling out diseases, such as tumors, infections, and injuries. Headaches can have multiple causes related to the function of the muscular, circulatory and/or nervous systems of the body. Though identifying the underlying cause is helpful for optimal treatment, it is not always possible or necessary for many pain management programs.
Headache treatments are used for (1) prevention and (2) pain mitigation. Depending on the type of headache and accompanying symptoms, the neurologist may prescribe medications, counseling, behavioral modifications, or stress management.
Recommendations for patients
Know your headache. Before visiting a physician, be prepared to describe your symptoms. The physician will want to know where on the head and neck the headaches are occurring, what they feel like, their frequency of occurrence, and information about any other symptoms that accompany the headaches, such as nausea. It is also important to know your medical history, particularly if there is anything in your past (such as a head injury), or anything in your family medical history that may help to explain the headaches. Keeping a diary that describes each headache occurrence can be very helpful.