Reasons to See a Neurosurgeon for Migraines
Most migraines are diagnosed and managed by a primary care provider or neurologist. However, you’ll want to see a neurosurgeon when your headaches point to a structural cause, such as a Chiari malformation, elevated pressure inside the skull, a tumor, or a problem in the upper cervical spine, or when an irritated nerve is driving the pain.
In this post, we’ll be discussing the difference between a true migraine and a headache that only looks like one, the warning signs that call for a neurosurgical evaluation, and what you can expect when you visit us here at Neurosurgery & Spine Consultants. We’ve also included an interactive headache pattern checker to help you sort through your symptoms. Read on to learn more!
Migraine vs. a Headache That Looks Like Migraine
A migraine is a primary headache disorder, meaning the headache itself is the condition. According to the National Institute of Neurological Disorders and Stroke (NINDS), migraine typically causes throbbing or pulsing pain, often on one side of the head, and is commonly paired with nausea and sensitivity to light and sound.
A secondary headache, on the other hand, is caused by something else going on in the body, such as a structural problem in the brain, a buildup of fluid, or an irritated nerve in the neck. Secondary headaches can look a lot like migraine, which is why a headache that doesn’t follow the usual migraine playbook deserves a closer look. NINDS outlines many of these secondary causes in its Headache: Hope Through Research guide. If you’ve dealt with headaches for years, our post on chronic headaches is a helpful companion to this one.
Reasons You May Want to See a Neurosurgeon
Let’s explore the most common reasons a patient with migraine-like headaches may benefit from a neurosurgical evaluation:
Your Headache Pattern Has Suddenly Changed
If you’ve had migraines for years and they suddenly feel different, happen more often, or no longer respond to the treatments that used to work, said change is worth investigating. New headaches that begin after age 50 also deserve a closer look.
Headaches Triggered by Coughing, Sneezing, or Straining
A headache at the back of the head that is set off by coughing, sneezing, laughing, or straining is a classic sign of a Chiari malformation, a condition in which part of the brain sits lower than normal and crowds the opening at the base of the skull. Chiari malformation is one of the cranial conditions our neurosurgeons treat.
Headaches That Are Worse When Lying Down or Upon Waking
Headaches that are at their worst first thing in the morning or when you lie flat, especially when paired with blurred or double vision, may be a sign of elevated intracranial pressure, such as hydrocephalus.
Headaches That Come with New Neurological Symptoms
Headaches that steadily worsen over weeks and come along with new balance problems, personality changes, or weakness may point to a mass, such as a meningioma. While most headaches are not caused by a tumor, it’s important to rule out anything and everything when these signs appear.
Pain That Starts in Your Neck or at the Base of Your Skull
Not every headache starts in the head. Irritated joints, discs, or nerves in the upper cervical spine can refer pain up into the head, a condition called cervicogenic headache. Irritation of the occipital nerves can also cause sharp, shooting, electric pain over the back of the head, known as occipital neuralgia. Both are commonly mistaken for migraine, and both fall right in line with the neck issues we treat.
Headaches That Began After a Head or Neck Injury
Whether it was a car accident, a fall, or a sports injury, headaches that started after trauma should be evaluated to make sure there’s no injury to the brain or cervical spine behind them.
Migraines That Haven’t Responded to Treatment
If you’ve tried multiple medications and treatment plans without relief, a neurosurgical review of your imaging can help confirm there isn’t a structural cause being missed, and it can give you and your neurologist a clearer path forward.
Headache Pattern Checker
Check any statements that describe your headaches. The checker will show which pattern your symptoms fit and the next step we’d recommend. The table below it lists every sign and what it may point to.
Your result will appear here
Select any statements on the left that describe your headaches.
Your answers match a typical migraine pattern
A primary care provider or neurologist is usually the best first stop for this pattern. If treatment isn’t working, or new warning signs appear, we’re here to help.
A neurosurgical evaluation is worth scheduling
One or more of your answers can point to a structural or nerve-related cause that a neurosurgeon should evaluate.
Call 911 or go to the nearest emergency department now
One or more of your answers can be a sign of a medical emergency. Please don’t wait for an appointment.
Your answers may point to:
Or call our office at 210-255-8935.
This checker sorts symptoms by pattern and urgency. It is not a diagnosis and does not replace an exam.
| Sign | What It May Point To | Next Step |
|---|---|---|
| The worst headache of your life, reaching full strength within a minute | Bleeding in or around the brain | Emergency |
| Headache with a fever and a stiff neck | Infection, such as meningitis | Emergency |
| Sudden weakness, numbness, confusion, trouble speaking, or vision loss | Stroke or another urgent brain condition | Emergency |
| Headaches set off by coughing, sneezing, or straining | Chiari malformation | See a neurosurgeon |
| Headaches worse when lying down or on waking, with vision changes | Elevated intracranial pressure, such as hydrocephalus | See a neurosurgeon |
| New headaches after age 50, or a clearly changed pattern | A secondary cause that may need imaging | See a neurosurgeon |
| Pain starting in the neck or base of the skull, or shooting pain over the back of the head | Cervicogenic headache or occipital neuralgia | See a neurosurgeon |
| Headaches that started after a head or neck injury | An injury to the brain or cervical spine | See a neurosurgeon |
| Steadily worsening headaches with new balance problems or personality changes | A mass, such as a meningioma | See a neurosurgeon |
| Throbbing one-sided pain with nausea, light and sound sensitivity, or a brief visual aura | Typical migraine | Primary care or neurologist |
Why a Neurosurgeon, and Not Just a Neurologist?
Neurologists and neurosurgeons often work hand in hand when it comes to headaches. A neurologist is typically the expert in diagnosing migraine and managing it with medication. A neurosurgeon’s role is to identify and treat structural and nerve-related causes, the kind of problems medication alone can’t fix.
That may include relieving pressure at the base of the skull with a Chiari malformation, draining excess fluid with hydrocephalus, removing a tumor, or addressing a problem in the cervical spine. In many cases, the visit simply confirms there is no structural cause, which gives you peace of mind and allows your migraine care to move forward with confidence. You can learn more about our board-certified neurosurgeons and their areas of expertise.
What to Expect at Your Visit
Your appointment will begin with a detailed conversation about your headache history, including when your headaches started, what they feel like, and what makes them better or worse. Your provider will then perform a neurological exam to check your strength, sensation, reflexes, balance, and vision.
From there, your provider may review any existing imaging or order new tests, such as an MRI of the brain or cervical spine, a CT scan, or imaging of the blood vessels. If you’re a new patient, our first visit page walks you through what to bring and how to prepare.
Some Helpful Tips Before Your Appointment
Here are some tips which can help you and your provider get the most out of your visit:
Keep a Headache Diary: Track when each headache starts, how long it lasts, where you feel it, and anything that seemed to trigger it. Patterns are one of the most valuable clues we have.
Bring Your Imaging: If you’ve had an MRI or CT scan, bring the discs and reports so your provider can review the images directly.
List Your Medications: Include everything you’ve tried for your headaches, what helped, and what didn’t.
Watch Your Pain Reliever Use: Taking pain relievers too often can lead to medication overuse headaches, which can make an underlying problem harder to sort out. Let your provider know how often you take them.
Try Our Headache Checker: For a more detailed look at your symptoms, our Headache & Cranial Nerve Checker can help you organize them before your visit.
Frequently Asked Questions
Do neurosurgeons treat migraines?
Neurosurgeons do not usually manage typical migraines, which are most often treated by a primary care provider or neurologist. A neurosurgeon becomes involved when headaches may have a structural cause, such as a Chiari malformation, hydrocephalus, a brain tumor, or a problem in the upper cervical spine or occipital nerves.
When should I worry that a headache is more than a migraine?
Be concerned when a headache is sudden and severe, comes with fever and a stiff neck, causes weakness, numbness, confusion, or vision loss, is triggered by coughing or straining, worsens when lying down, or represents a clear change from your usual pattern. Sudden or neurological symptoms need emergency care right away.
Can a problem in the neck cause migraine-like headaches?
Yes. Irritated joints, discs, or nerves in the upper cervical spine can refer pain into the head, a condition called cervicogenic headache. Irritation of the occipital nerves can also cause sharp, shooting pain over the back of the head. Both are sometimes mistaken for migraine and may need a spine evaluation.
Will I need surgery if I see a neurosurgeon for headaches?
Not necessarily. Many patients who see a neurosurgeon for headaches never need an operation. The visit often focuses on reviewing imaging, ruling out structural causes, and recommending the right next step, which may include medication, physical therapy, nerve-based treatments, or coordination with a neurologist.
What tests might a neurosurgeon order for headaches?
Depending on your symptoms and exam, a neurosurgeon may order an MRI of the brain or cervical spine, a CT scan, or specialized imaging of the blood vessels. If you already have imaging, bring the discs and reports to your visit so your provider can review them directly.
Should I see a neurologist or a neurosurgeon for migraines?
For typical migraine attacks, a neurologist or primary care provider is usually the best first stop. A neurosurgeon is the right choice when imaging shows a structural finding, when warning signs suggest a secondary cause, or when headaches appear connected to the neck or a specific nerve.
Don’t Let Headaches Hold You Back!
Living with frequent headaches is exhausting, and you deserve answers. If your headaches have changed, aren’t responding to treatment, or come with any of the warning signs above, you’ll want to contact us using the form below or call our office at 210-255-8935. We’ll be sure to respond as soon as possible. We look forward to hearing from you soon!
DISCLAIMER: No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.