Headaches: When to See a Neurologist for Relief

I have a headache that radiates to the back of my head, with a hot sensation on my forehead and warmth in my upper back?

Hello Dr.
Jiang: Since the end of January, I have been experiencing pain in my forehead, which has now shifted to the lower back of my head, causing me to wake up in pain.
I also feel heat in my forehead and upper back.
I haven't had time to see a doctor due to the Spring Festival holiday.
Which specialty should I consult? Thank you.

Yang Shuzhen, 60~69 year old female. Ask Date: 2024/02/17

Dr. Jiang Junyi reply Neurology

Hello Ms.
Yang,
You mentioned that "the frontal headache has now shifted to pain in the lower back of the head, waking you up in pain, along with heat in the forehead and upper back." It is important to first consider cervicogenic headache.
This type of headache is caused by issues related to the cervical spine and is classified as a "secondary" headache.
Pain in the cervical vertebrae at levels two and three can refer to the back of the head and the sides of the neck.
Additionally, the fascia is interconnected, so improper pressure on the neck can lead to muscle tension, which in turn can cause headaches, eye strain, pain in the back of the head, stiffness in the shoulders and neck, and discomfort in the interscapular region.
Common causes include:
1.
Poor posture: Prolonged poor posture, such as looking down at a smartphone, rounded shoulders, and kyphosis (as seen in upper crossed syndrome), can lead to excessive tightness in the muscles and soft tissues around the occipital area, compressing the suboccipital nerve, greater occipital nerve, and greater auricular nerve, resulting in pain in the back of the head, sides of the head, and pain around the occipital area, ears, and orbits.
2.
Cervical degeneration: Cervicogenic headaches are often associated with degeneration of the first, second, and third cervical vertebrae, which can compress the occipital nerve, leading to headaches or facial pain.
Degenerative issues may include bone spurs, cervical disc herniation, cervical facet joint arthritis, and cervical spinal stenosis.
3.
Neck injuries: Sports injuries, falls, or car accidents can also contribute to these symptoms.
I recommend consulting with a rehabilitation specialist or a neurologist to discuss examination and treatment options for nerve repair.
It may also be beneficial to supplement with B vitamins and to avoid poor posture.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology Department, Taoyuan Hospital

Reply Date: 2024/02/17

More Info

When it comes to understanding headaches and determining when to seek help from a neurologist, it's essential to recognize the various types of headaches and their potential underlying causes. Your symptoms, which include pain that has shifted from the forehead to the lower back of the head, along with sensations of heat in the forehead and upper back, warrant a thorough evaluation.

Headaches can be classified into primary and secondary types. Primary headaches, such as migraines and tension-type headaches, are not caused by underlying medical conditions. Secondary headaches, on the other hand, are symptoms of another issue, such as an injury, infection, or other neurological conditions. Given your description of the pain's location and the accompanying sensations, it is crucial to consider both categories.

The fact that your headache has changed in location and intensity could indicate a more complex issue. For instance, tension-type headaches often present as a tight band around the head and can be exacerbated by stress, poor posture, or muscle tension in the neck and shoulders. Migraines, characterized by throbbing pain, can also cause associated symptoms like nausea and sensitivity to light and sound. However, if the headache is accompanied by unusual sensations, such as warmth or changes in sensation, it may suggest a secondary headache that requires further investigation.

In your case, the shift from the forehead to the lower back of the head, along with the heat sensations, could be indicative of several conditions, including tension headaches, cervicogenic headaches (originating from the cervical spine), or even more serious conditions like intracranial hypertension or other neurological issues. The fact that you are waking up with pain suggests that it may be affecting your sleep quality, which can further exacerbate the headache cycle.

Given these considerations, it is advisable to consult a neurologist. A neurologist specializes in diagnosing and treating disorders of the nervous system, including headaches. They can perform a comprehensive evaluation, which may include a detailed medical history, physical examination, and possibly imaging studies such as MRI or CT scans to rule out any serious underlying conditions.

In addition to seeking medical advice, there are several self-care strategies you can implement to help manage your headaches. These include maintaining a regular sleep schedule, staying hydrated, practicing relaxation techniques such as yoga or meditation, and avoiding known headache triggers, which can vary from person to person. Keeping a headache diary can also be beneficial, as it allows you to track the frequency, duration, and intensity of your headaches, as well as any potential triggers.

In summary, your symptoms warrant a visit to a neurologist for a thorough evaluation and appropriate management. Early intervention can help prevent the progression of headaches and improve your overall quality of life. Don't hesitate to seek help, as effective treatments are available, and understanding the underlying causes of your headaches is the first step toward relief.

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