Back to Back Issues Page
HeadWay Issue #221 - When is it time to see a Specialist?
March 21, 2023

In this issue:

When is it time to see a Specialist?

Recently @ Headache and Migraine News

Say what?! Acute Angle Closure Glaucoma

When is it time to see a Specialist?

Specialized headache treatment shouldn't be a luxury, but for some people, it is. Although most headache patients should probably get to a specialist sooner, for reasons of distance or economics, it's not always easy.

The National Neurosciences Advisory Group (NNAG) in the UK recently published some recommendations which may help you make that final leap to a specialist if you haven't seen one yet.

This is only a quick summary of their suggestions, and the categories are mine, so if you want to read more visit the NNAG site for more.

So, when should patients consider a specialist? Here are the general categories:

New or Changed Symptoms

New headache or changed symptoms should always mean a visit to the doctor. A "substantial" change, says the NNAG, certainly requires a specialist. But there are certain specific signs that the condition may require specialty treatment:
  • Headache/facial pain due to trauma
  • Headache/facial pain in a cancer or immunocompromised patient
  • Facial pain when there is a lump/swollen lymph nodes

Ongoing/Advanced Treatment

A specialist is also helpful when treatment is ongoing or needs to advance to less-common treatments.
  • Adolescents with ongoing headache/facial pain conditions
  • Patients with ongoing headache/facial pain who have already tried standard treatments

Rarer Conditions

A rare condition of any kind may benefit a lot from a specialist in that area. The NNAG does list some perhaps more common rare conditions. :)
  • New Daily Persistent Headache (a headache starting at a certain time and never going away)
  • Patients with cluster headache or another trigeminal autonomic cephalgia
  • "Patients with symptoms suggestive of painful trigeminal neuropathy or burning mouth syndrome"

Specialty Treatment or Urgent Care

Finally, patients requiring specialty treatment such as Botox, or patients who need to be tested/monitored/treated for more serious conditions (see Signs of an “Emergency Headache”).
  • Specialty care including Botox, CGRP related medications
  • Headache that is started with a change in posture, cough, exertion, etc.
  • Tumours
  • Trigeminal neuralgia
  • Acute angle closure glaucoma (sudden increased pressure inside the eye)
  • Giant cell arteritis
  • Any other "urgent headache", including any significant changes in symptoms
If you're not satisfied with your treatment, finding a specialist (or a new specialist) can be very helpful. But being aware of some of the categories above will help you to avoid wasting time and money when a specialist may have the special tools to get to the root of the problem much more quickly.

Recently @ Headache and Migraine News

A few recent articles that you may have missed:

Say what?! Acute Angle Closure Glaucoma

Acute angle closure glaucoma is, of course, a type of glaucoma. Glaucoma itself refers to a group of conditions that cause damage to the optic nerve.

Glaucoma doesn't necessarily include pressure in the eye, but it often does.

Acute angle closure glaucoma is especially relevant to today's topic because the pressure in the eye typically causes eye pain and severe headache, along with nausea, vision problems, and eye redness. Many of these symptoms can be seen in migraine as well.

In this case, drainage is blocked in your eye, leading to pressure, which increases rapidly - in a matter of hours. It's rare, but when it occurs it is a medical emergency.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
Back to Back Issues Page