When should you see a physician or specialist for your headaches?

I think the first step in treating your headaches is to go to your primary care doctor and get a correct diagnosis. And then once your on, or once you've tried some medications that are typically used to treat the headaches, if they aren't working, then that might be a good time to see a headache specialist. Also, if you have contraindications to some of the typical medications we would use for headaches, that would also be a good time to see a headache specialist.

There's a mnemonic called "SNOOP" for red flags, and these are things to look out for that may indicate something more serious going on. The "S" in SNOOP stands for systemic symptoms or illnesses. So if you have any fevers, weight loss or any history of HIV or cancer, seek help. "O" is for onset that is sudden. So what we call a "thunder clap headache." If you have a very severe headache that peaks within seconds. Also the onset of a new headache after the age of 40 is a red flag. The four "P's", the first one is if there is a change in your previous headache pattern. If you have a postural component, meaning your headache gets worse either in the upright or laying position. If you have a headache that is precipitated by Valsalva maneuvers, such as bearing down on the toilet, and if you're currently pregnant and have a new or worsening headache. Those three situations is where you would seek help by a physician.

And so like I mentioned, tension-type headache, 70-80 percent of people can get those, so like you said, a lot of people get headaches that don't really bother them. So episodic tension-type headache doesn't really bother people, so we don't really see that in clinic, because people just go and take Tylenol or ibuprofen by themselves, and the headache goes away. So with tension-type headache, it's really people with chronic tension-type headache that go to seek help from their doctors. And then people with migraine, some of them do treat themselves at home, but a lot of times most of the patients we see are patients with migraine or chronic migraine.