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I've Had A Headache Now For More Than A Month
Question: I've had a headache now for more than a month and I have a tender spot on top of my head. Should I see a doctor and should I seek out a specialist?
I've had a headache now for more than a month and I have a tender spot on top of my head. Should I see a doctor and should I seek out a specialist?
Brief Answer:
As a headache specialist I'm obviously BIASED
Detailed Answer:
Good morning and thank you for your question on this platform.
Well, to be directly responsive to your question.....I am fully partial to the idea that headaches should be treated by headache specialists....or at least neurologists with an INTEREST in headaches. However, the reality is over 60% of all patients treated for headaches are taken care of by their primary care physicians. A mere 40% are treated by non-primary care which would then, include neurologists, non-neurologists, and of course, Headache Specialists.
I would think that seeing your primary care provider initially (for your type of headache) is a reasonable thing to do. It doesn't sound as if you're having any type of neurological symptoms that would suggest this to be a complicated or NON-routine sort of headache at this point. And so for those reasons I believe seeing a primary doctor is a good move right now. Of course, if your symptoms become more complicated with time, or any treatment that seems to be working suddenly stops and the doctor doesn't really know where to go from there then, it would be time to call in the cavalry with either a neurologist or even a Headache Specialist.
With your headache persisting now for 1 month and your taking OTC medications my fear is that you may be or may have already passed into some form of MEDICATION OVERUSE syndrome and that the persistence of your headache may not so much be based on the type of headache it is or what's at the root of the problem so much as it may be a phenomenon related to taking TOO MANY DOSES of analgesics which most people (even doctors) would consider benign and not harmful at all...so long as labeled instructions were followed.
However, the truth about labeling instructions and OTC medications is that people don't always follow those instructions. Or another thing that frequently happens is that instructions do NOT REFLECT the actual science of headache management and manufacturers of OTC drugs may lead people to believe that it is altogether safe to be take their medications on a daily basis.
Medication Overuse Headache (MOH) is somewhat of a debated topic in the headache community, however, it is recognized as an entity in the latest ICHD version on the subject (International Classification of Headache Diseases) and I for one do believe in its existence in certain individuals so I promote the concept to my patients. And it goes something like this.
When treating headaches with simple analgesics (Tylenol, Excedrin, Bayer, Motrin, Advil) which can be both OTC as well as prescribed one should not treat their headaches with more than 15 days of any such medication per month. I actually limit my patients to 15 DOSES per month to be absolutely sure they do not overrun the consensus RED LINE. When treating with more complicated agents such as triptans (Imitrex, Maxalt, Zomig, etc.) or combination drugs such as Treximet (sumatriptan and Naproxen) the limit is 10 days monthly. And MY limit goes to 10 DOSES monthly. In this way we try and educate our patients on limiting headache treatment with medication to a rather small portion of the monthly time they may feel they have them SO THAT WE CAN SPEND THE LION'S SHARE OF THE TIME discovering the CAUSE of the headaches and attacking that aspect of things.....the ROOT of the problem if you will.
Once the underlying cause of a headache you've had for 1 month with a tender spot on the top of the head is better understood then, there is less risk that you'd be overusing analgesic medications. Do you agree? In order to go through this process, however, requires some degree of persistence, documentation by the patient, and analysis of that documentation by the doctor.....Oh, I almost forgot.....the physician also needs to get a very good history from the patient on what's been going on in their lives over the past number of months leading up when all this started as well as get to know the patient's lifestyle and habits to tell whether anything there could be offending.
Here's another point that many people forget about. Often times, new onset headaches in people who do not have a history of headaches could be as a side effect to other medications they've recently been taking for a variety of things such as blood pressure control, depression/anxiety, diabetic control, etc. And so a meticulous survey of one's medication regimen as well as medications that are relatively new to a regimen is tantamount some times to discovering the actual cause of a headache or headaches.
And so kind sir, in your particular case I believe since you've had this headache for 1 month now (and NOTHING prior as I understand) I do think it would behoove you to see a physician-- preferably one interested in looking into the cause of this headache as opposed to merely prescribing more medicine (which you've already been taking) without trying to get at the root cause. The physician could also examine the area atop your head that is tender to see whether you actually something physically on top or within the scalp that could causing this problem. I'm sure you would've noticed something obvious such as a crusty scab, lump that wasn't there before, or other architecturally different entity as you would've said something, but just being able to pinpoint the discomfort for the physician with his finger may yield some interesting ideas as to what may be going on.
Of course, if the physician is really going to give you the full Magilla he/she will ask you to fill out a HEADACHE DIARY for a period of at least several weeks and explain the elements of a standard diary that will have you keeping track of symptoms, triggers, durations, and other characteristics of the headaches in an effort to discover a pattern. Whenever I have people fill out diaries I always insist that they NOT CHANGE and NOT ALTER their current regimen of medications or interventions that they are carrying out to treat themselves. I want them to show me in a snapshot of time EXACTLY what they're doing for their headaches, how well or not the intervention or medication is working, and what if any other things could be related to the onset or OFFset of these headaches. They keep track of caffeine ingestion, alcohol use, amount of sleep obtained, episodes of anxiety or depression that may be particularly egregious and could be setting off or making worse these headaches.
So, now I hope you can see why asking whether to see a doctor or specialist is preferable is not the easiest decision to make? Kind of depends on what you're looking for in terms of long term results and reasons as to why you've got this headache. I'm a bit biased as a headache neurologist myself at the detail and diligence that a specialist might bring to such a problem compared to a non-specialist.
I took the XXXXXXX of looking up some information online with respect to headache specialists in your region of Mechanicsville, MD vs. neurologists. Seems like there are plenty of neurologists and I was able to find one practice that specializes in headaches. If you decide to go to either then, I'd recommend doing a little bit of evaluating (tough to do on the internet and be totally objective about it)...but just looking may give you an idea of whether or not the doctors that are highlighted and what the patients are saying about them blends with what you may be looking for in a doctor for this problem.
If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 59 minutes of professional time to research, assimilate, and respond in complete form.
As a headache specialist I'm obviously BIASED
Detailed Answer:
Good morning and thank you for your question on this platform.
Well, to be directly responsive to your question.....I am fully partial to the idea that headaches should be treated by headache specialists....or at least neurologists with an INTEREST in headaches. However, the reality is over 60% of all patients treated for headaches are taken care of by their primary care physicians. A mere 40% are treated by non-primary care which would then, include neurologists, non-neurologists, and of course, Headache Specialists.
I would think that seeing your primary care provider initially (for your type of headache) is a reasonable thing to do. It doesn't sound as if you're having any type of neurological symptoms that would suggest this to be a complicated or NON-routine sort of headache at this point. And so for those reasons I believe seeing a primary doctor is a good move right now. Of course, if your symptoms become more complicated with time, or any treatment that seems to be working suddenly stops and the doctor doesn't really know where to go from there then, it would be time to call in the cavalry with either a neurologist or even a Headache Specialist.
With your headache persisting now for 1 month and your taking OTC medications my fear is that you may be or may have already passed into some form of MEDICATION OVERUSE syndrome and that the persistence of your headache may not so much be based on the type of headache it is or what's at the root of the problem so much as it may be a phenomenon related to taking TOO MANY DOSES of analgesics which most people (even doctors) would consider benign and not harmful at all...so long as labeled instructions were followed.
However, the truth about labeling instructions and OTC medications is that people don't always follow those instructions. Or another thing that frequently happens is that instructions do NOT REFLECT the actual science of headache management and manufacturers of OTC drugs may lead people to believe that it is altogether safe to be take their medications on a daily basis.
Medication Overuse Headache (MOH) is somewhat of a debated topic in the headache community, however, it is recognized as an entity in the latest ICHD version on the subject (International Classification of Headache Diseases) and I for one do believe in its existence in certain individuals so I promote the concept to my patients. And it goes something like this.
When treating headaches with simple analgesics (Tylenol, Excedrin, Bayer, Motrin, Advil) which can be both OTC as well as prescribed one should not treat their headaches with more than 15 days of any such medication per month. I actually limit my patients to 15 DOSES per month to be absolutely sure they do not overrun the consensus RED LINE. When treating with more complicated agents such as triptans (Imitrex, Maxalt, Zomig, etc.) or combination drugs such as Treximet (sumatriptan and Naproxen) the limit is 10 days monthly. And MY limit goes to 10 DOSES monthly. In this way we try and educate our patients on limiting headache treatment with medication to a rather small portion of the monthly time they may feel they have them SO THAT WE CAN SPEND THE LION'S SHARE OF THE TIME discovering the CAUSE of the headaches and attacking that aspect of things.....the ROOT of the problem if you will.
Once the underlying cause of a headache you've had for 1 month with a tender spot on the top of the head is better understood then, there is less risk that you'd be overusing analgesic medications. Do you agree? In order to go through this process, however, requires some degree of persistence, documentation by the patient, and analysis of that documentation by the doctor.....Oh, I almost forgot.....the physician also needs to get a very good history from the patient on what's been going on in their lives over the past number of months leading up when all this started as well as get to know the patient's lifestyle and habits to tell whether anything there could be offending.
Here's another point that many people forget about. Often times, new onset headaches in people who do not have a history of headaches could be as a side effect to other medications they've recently been taking for a variety of things such as blood pressure control, depression/anxiety, diabetic control, etc. And so a meticulous survey of one's medication regimen as well as medications that are relatively new to a regimen is tantamount some times to discovering the actual cause of a headache or headaches.
And so kind sir, in your particular case I believe since you've had this headache for 1 month now (and NOTHING prior as I understand) I do think it would behoove you to see a physician-- preferably one interested in looking into the cause of this headache as opposed to merely prescribing more medicine (which you've already been taking) without trying to get at the root cause. The physician could also examine the area atop your head that is tender to see whether you actually something physically on top or within the scalp that could causing this problem. I'm sure you would've noticed something obvious such as a crusty scab, lump that wasn't there before, or other architecturally different entity as you would've said something, but just being able to pinpoint the discomfort for the physician with his finger may yield some interesting ideas as to what may be going on.
Of course, if the physician is really going to give you the full Magilla he/she will ask you to fill out a HEADACHE DIARY for a period of at least several weeks and explain the elements of a standard diary that will have you keeping track of symptoms, triggers, durations, and other characteristics of the headaches in an effort to discover a pattern. Whenever I have people fill out diaries I always insist that they NOT CHANGE and NOT ALTER their current regimen of medications or interventions that they are carrying out to treat themselves. I want them to show me in a snapshot of time EXACTLY what they're doing for their headaches, how well or not the intervention or medication is working, and what if any other things could be related to the onset or OFFset of these headaches. They keep track of caffeine ingestion, alcohol use, amount of sleep obtained, episodes of anxiety or depression that may be particularly egregious and could be setting off or making worse these headaches.
So, now I hope you can see why asking whether to see a doctor or specialist is preferable is not the easiest decision to make? Kind of depends on what you're looking for in terms of long term results and reasons as to why you've got this headache. I'm a bit biased as a headache neurologist myself at the detail and diligence that a specialist might bring to such a problem compared to a non-specialist.
I took the XXXXXXX of looking up some information online with respect to headache specialists in your region of Mechanicsville, MD vs. neurologists. Seems like there are plenty of neurologists and I was able to find one practice that specializes in headaches. If you decide to go to either then, I'd recommend doing a little bit of evaluating (tough to do on the internet and be totally objective about it)...but just looking may give you an idea of whether or not the doctors that are highlighted and what the patients are saying about them blends with what you may be looking for in a doctor for this problem.
If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 59 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
As a headache specialist I'm obviously BIASED
Detailed Answer:
Good morning and thank you for your question on this platform.
Well, to be directly responsive to your question.....I am fully partial to the idea that headaches should be treated by headache specialists....or at least neurologists with an INTEREST in headaches. However, the reality is over 60% of all patients treated for headaches are taken care of by their primary care physicians. A mere 40% are treated by non-primary care which would then, include neurologists, non-neurologists, and of course, Headache Specialists.
I would think that seeing your primary care provider initially (for your type of headache) is a reasonable thing to do. It doesn't sound as if you're having any type of neurological symptoms that would suggest this to be a complicated or NON-routine sort of headache at this point. And so for those reasons I believe seeing a primary doctor is a good move right now. Of course, if your symptoms become more complicated with time, or any treatment that seems to be working suddenly stops and the doctor doesn't really know where to go from there then, it would be time to call in the cavalry with either a neurologist or even a Headache Specialist.
With your headache persisting now for 1 month and your taking OTC medications my fear is that you may be or may have already passed into some form of MEDICATION OVERUSE syndrome and that the persistence of your headache may not so much be based on the type of headache it is or what's at the root of the problem so much as it may be a phenomenon related to taking TOO MANY DOSES of analgesics which most people (even doctors) would consider benign and not harmful at all...so long as labeled instructions were followed.
However, the truth about labeling instructions and OTC medications is that people don't always follow those instructions. Or another thing that frequently happens is that instructions do NOT REFLECT the actual science of headache management and manufacturers of OTC drugs may lead people to believe that it is altogether safe to be take their medications on a daily basis.
Medication Overuse Headache (MOH) is somewhat of a debated topic in the headache community, however, it is recognized as an entity in the latest ICHD version on the subject (International Classification of Headache Diseases) and I for one do believe in its existence in certain individuals so I promote the concept to my patients. And it goes something like this.
When treating headaches with simple analgesics (Tylenol, Excedrin, Bayer, Motrin, Advil) which can be both OTC as well as prescribed one should not treat their headaches with more than 15 days of any such medication per month. I actually limit my patients to 15 DOSES per month to be absolutely sure they do not overrun the consensus RED LINE. When treating with more complicated agents such as triptans (Imitrex, Maxalt, Zomig, etc.) or combination drugs such as Treximet (sumatriptan and Naproxen) the limit is 10 days monthly. And MY limit goes to 10 DOSES monthly. In this way we try and educate our patients on limiting headache treatment with medication to a rather small portion of the monthly time they may feel they have them SO THAT WE CAN SPEND THE LION'S SHARE OF THE TIME discovering the CAUSE of the headaches and attacking that aspect of things.....the ROOT of the problem if you will.
Once the underlying cause of a headache you've had for 1 month with a tender spot on the top of the head is better understood then, there is less risk that you'd be overusing analgesic medications. Do you agree? In order to go through this process, however, requires some degree of persistence, documentation by the patient, and analysis of that documentation by the doctor.....Oh, I almost forgot.....the physician also needs to get a very good history from the patient on what's been going on in their lives over the past number of months leading up when all this started as well as get to know the patient's lifestyle and habits to tell whether anything there could be offending.
Here's another point that many people forget about. Often times, new onset headaches in people who do not have a history of headaches could be as a side effect to other medications they've recently been taking for a variety of things such as blood pressure control, depression/anxiety, diabetic control, etc. And so a meticulous survey of one's medication regimen as well as medications that are relatively new to a regimen is tantamount some times to discovering the actual cause of a headache or headaches.
And so kind sir, in your particular case I believe since you've had this headache for 1 month now (and NOTHING prior as I understand) I do think it would behoove you to see a physician-- preferably one interested in looking into the cause of this headache as opposed to merely prescribing more medicine (which you've already been taking) without trying to get at the root cause. The physician could also examine the area atop your head that is tender to see whether you actually something physically on top or within the scalp that could causing this problem. I'm sure you would've noticed something obvious such as a crusty scab, lump that wasn't there before, or other architecturally different entity as you would've said something, but just being able to pinpoint the discomfort for the physician with his finger may yield some interesting ideas as to what may be going on.
Of course, if the physician is really going to give you the full Magilla he/she will ask you to fill out a HEADACHE DIARY for a period of at least several weeks and explain the elements of a standard diary that will have you keeping track of symptoms, triggers, durations, and other characteristics of the headaches in an effort to discover a pattern. Whenever I have people fill out diaries I always insist that they NOT CHANGE and NOT ALTER their current regimen of medications or interventions that they are carrying out to treat themselves. I want them to show me in a snapshot of time EXACTLY what they're doing for their headaches, how well or not the intervention or medication is working, and what if any other things could be related to the onset or OFFset of these headaches. They keep track of caffeine ingestion, alcohol use, amount of sleep obtained, episodes of anxiety or depression that may be particularly egregious and could be setting off or making worse these headaches.
So, now I hope you can see why asking whether to see a doctor or specialist is preferable is not the easiest decision to make? Kind of depends on what you're looking for in terms of long term results and reasons as to why you've got this headache. I'm a bit biased as a headache neurologist myself at the detail and diligence that a specialist might bring to such a problem compared to a non-specialist.
I took the XXXXXXX of looking up some information online with respect to headache specialists in your region of Mechanicsville, MD vs. neurologists. Seems like there are plenty of neurologists and I was able to find one practice that specializes in headaches. If you decide to go to either then, I'd recommend doing a little bit of evaluating (tough to do on the internet and be totally objective about it)...but just looking may give you an idea of whether or not the doctors that are highlighted and what the patients are saying about them blends with what you may be looking for in a doctor for this problem.
If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 59 minutes of professional time to research, assimilate, and respond in complete form.
As a headache specialist I'm obviously BIASED
Detailed Answer:
Good morning and thank you for your question on this platform.
Well, to be directly responsive to your question.....I am fully partial to the idea that headaches should be treated by headache specialists....or at least neurologists with an INTEREST in headaches. However, the reality is over 60% of all patients treated for headaches are taken care of by their primary care physicians. A mere 40% are treated by non-primary care which would then, include neurologists, non-neurologists, and of course, Headache Specialists.
I would think that seeing your primary care provider initially (for your type of headache) is a reasonable thing to do. It doesn't sound as if you're having any type of neurological symptoms that would suggest this to be a complicated or NON-routine sort of headache at this point. And so for those reasons I believe seeing a primary doctor is a good move right now. Of course, if your symptoms become more complicated with time, or any treatment that seems to be working suddenly stops and the doctor doesn't really know where to go from there then, it would be time to call in the cavalry with either a neurologist or even a Headache Specialist.
With your headache persisting now for 1 month and your taking OTC medications my fear is that you may be or may have already passed into some form of MEDICATION OVERUSE syndrome and that the persistence of your headache may not so much be based on the type of headache it is or what's at the root of the problem so much as it may be a phenomenon related to taking TOO MANY DOSES of analgesics which most people (even doctors) would consider benign and not harmful at all...so long as labeled instructions were followed.
However, the truth about labeling instructions and OTC medications is that people don't always follow those instructions. Or another thing that frequently happens is that instructions do NOT REFLECT the actual science of headache management and manufacturers of OTC drugs may lead people to believe that it is altogether safe to be take their medications on a daily basis.
Medication Overuse Headache (MOH) is somewhat of a debated topic in the headache community, however, it is recognized as an entity in the latest ICHD version on the subject (International Classification of Headache Diseases) and I for one do believe in its existence in certain individuals so I promote the concept to my patients. And it goes something like this.
When treating headaches with simple analgesics (Tylenol, Excedrin, Bayer, Motrin, Advil) which can be both OTC as well as prescribed one should not treat their headaches with more than 15 days of any such medication per month. I actually limit my patients to 15 DOSES per month to be absolutely sure they do not overrun the consensus RED LINE. When treating with more complicated agents such as triptans (Imitrex, Maxalt, Zomig, etc.) or combination drugs such as Treximet (sumatriptan and Naproxen) the limit is 10 days monthly. And MY limit goes to 10 DOSES monthly. In this way we try and educate our patients on limiting headache treatment with medication to a rather small portion of the monthly time they may feel they have them SO THAT WE CAN SPEND THE LION'S SHARE OF THE TIME discovering the CAUSE of the headaches and attacking that aspect of things.....the ROOT of the problem if you will.
Once the underlying cause of a headache you've had for 1 month with a tender spot on the top of the head is better understood then, there is less risk that you'd be overusing analgesic medications. Do you agree? In order to go through this process, however, requires some degree of persistence, documentation by the patient, and analysis of that documentation by the doctor.....Oh, I almost forgot.....the physician also needs to get a very good history from the patient on what's been going on in their lives over the past number of months leading up when all this started as well as get to know the patient's lifestyle and habits to tell whether anything there could be offending.
Here's another point that many people forget about. Often times, new onset headaches in people who do not have a history of headaches could be as a side effect to other medications they've recently been taking for a variety of things such as blood pressure control, depression/anxiety, diabetic control, etc. And so a meticulous survey of one's medication regimen as well as medications that are relatively new to a regimen is tantamount some times to discovering the actual cause of a headache or headaches.
And so kind sir, in your particular case I believe since you've had this headache for 1 month now (and NOTHING prior as I understand) I do think it would behoove you to see a physician-- preferably one interested in looking into the cause of this headache as opposed to merely prescribing more medicine (which you've already been taking) without trying to get at the root cause. The physician could also examine the area atop your head that is tender to see whether you actually something physically on top or within the scalp that could causing this problem. I'm sure you would've noticed something obvious such as a crusty scab, lump that wasn't there before, or other architecturally different entity as you would've said something, but just being able to pinpoint the discomfort for the physician with his finger may yield some interesting ideas as to what may be going on.
Of course, if the physician is really going to give you the full Magilla he/she will ask you to fill out a HEADACHE DIARY for a period of at least several weeks and explain the elements of a standard diary that will have you keeping track of symptoms, triggers, durations, and other characteristics of the headaches in an effort to discover a pattern. Whenever I have people fill out diaries I always insist that they NOT CHANGE and NOT ALTER their current regimen of medications or interventions that they are carrying out to treat themselves. I want them to show me in a snapshot of time EXACTLY what they're doing for their headaches, how well or not the intervention or medication is working, and what if any other things could be related to the onset or OFFset of these headaches. They keep track of caffeine ingestion, alcohol use, amount of sleep obtained, episodes of anxiety or depression that may be particularly egregious and could be setting off or making worse these headaches.
So, now I hope you can see why asking whether to see a doctor or specialist is preferable is not the easiest decision to make? Kind of depends on what you're looking for in terms of long term results and reasons as to why you've got this headache. I'm a bit biased as a headache neurologist myself at the detail and diligence that a specialist might bring to such a problem compared to a non-specialist.
I took the XXXXXXX of looking up some information online with respect to headache specialists in your region of Mechanicsville, MD vs. neurologists. Seems like there are plenty of neurologists and I was able to find one practice that specializes in headaches. If you decide to go to either then, I'd recommend doing a little bit of evaluating (tough to do on the internet and be totally objective about it)...but just looking may give you an idea of whether or not the doctors that are highlighted and what the patients are saying about them blends with what you may be looking for in a doctor for this problem.
If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 59 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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