Clinical Approach to Chronic Headaches and Migraine: When to Refer to a Neurologist

Headaches are among the most common neurological complaints in clinical practice. While many are benign and self-limiting, a subset of patients experience chronic or severe episodes that significantly impact their quality of life. Differentiating between primary headache disorders—such as migraines and tension-type headaches—and secondary headaches caused by underlying pathology is essential.

This article explores the classification of headache types, the indicators that warrant referral to a neurologist, and the management strategies offered by specialists.

Types of Headaches: Clinical Differentiation

Headaches are broadly classified into:

• Primary headaches – Including migraine, tension-type, and cluster headaches.
• Secondary headaches – Arising due to structural or metabolic abnormalities (e.g., brain tumors, hypertension, sinusitis, infections).

Migraines, in particular, often present with unilateral throbbing pain, nausea, photophobia, and sometimes auras (visual or sensory disturbances preceding the headache). Cluster headaches, though less common, are excruciating and typically occur in cycles.

Patients with chronic headaches should be evaluated for red flags such as:

• Sudden onset “thunderclap” headache
• New or worsening headache in patients over 50
• Headache associated with neurological deficits
• Headaches triggered by exertion, coughing, or postural changes

When Should a Neurologist Be Involved?

Patients with frequent headaches unresponsive to over-the-counter medications, or those with warning signs indicating possible intracranial pathology, should be referred to a neurologist for further evaluation.

Diagnostic workup may include:

• Neurological examination
• Brain imaging (MRI/CT)
• Blood tests to rule out systemic causes
• Evaluation for migraine variants and neurological mimics

Neurologists not only confirm diagnosis but also formulate long-term management strategies using:

• Acute and preventive pharmacotherapy
• Trigger identification and lifestyle modifications
• Behavioral therapy or biofeedback (when needed)

In Siliguri, patients experiencing persistent headache disorders can consult Dr. Shveta Gupta, a neurologist with advanced training in headache and migraine care. Her clinical approach at Mahabir Doctor’s Hub emphasizes accurate diagnosis and individualized treatment plans.

Persistent or severe headaches should not be dismissed as routine discomfort. A structured diagnostic approach and expert neurological input can lead to effective relief and improved patient outcomes. Early consultation with a neurologist ensures timely intervention and helps rule out serious underlying conditions.