Private headache clinic in London, same-day specialist medicine.

Other features needing prompt assessment

• a new headache over the age of 50, particularly with scalp tenderness or jaw ache on chewing — possible giant cell arteritis, which can cause sudden blindness
• headache worse on lying down, coughing, straining or bending
• headache that wakes you from sleep, or is worst first thing and improves through the day
• a headache that has changed in character from your usual pattern
• headache with weight loss, fever or night sweats
• headache in someone immunosuppressed or with a history of cancer
• headache in pregnancy or just after birth, with visual change or swelling

The common types

• Tension-type — a band of pressure around the head, both sides, mild to moderate, not worsened by activity, without nausea. The commonest by far.
• Migraine — usually one-sided, throbbing, moderate to severe, lasting 4 to 72 hours, worsened by movement, with nausea and dislike of light or sound. Sometimes preceded by aura.
• Cluster headache — excruciating pain around one eye, lasting 15 minutes to 3 hours, occurring daily in bouts over weeks, with a red watering eye, drooping lid and blocked nostril on that side. People are restless and pace rather than lying still.
• Sinus headache — genuinely uncommon, and frequently a misdiagnosed migraine. Real sinusitis has nasal blockage and discoloured discharge.
• Cervicogenic — arising from the neck, often one-sided, with restricted neck movement.

Cluster headache is not migraine

It is often misdiagnosed for years, and the treatments are different: high-flow oxygen and injectable or nasal triptans for attacks, and verapamil for prevention. Ordinary painkillers do nothing — attacks are over before tablets are absorbed. If you have strictly one-sided attacks around the eye with tearing and a blocked nose, lasting under three hours and coming in daily bouts, say so specifically.

Do you need a scan?

For most headaches, no. Imaging is not recommended for typical migraine or tension-type headache with a normal examination, because the yield is very low and incidental findings cause harm. Scans are indicated where red flags are present, the examination is abnormal, the pattern has changed, or there is a specific concern — and in those situations they should be arranged promptly.

Keeping a diary

Two months of a simple headache diary — date, duration, severity, features, what you took and how many days a month — is more useful than any test for headaches without red flags. It identifies the type, reveals medication overuse, and shows triggers. Bring it to your appointment.