Chronic Headaches: Which Specialist Should You Consult?

Hello, doctor: I often have headaches and I'm not sure which specialty I should see?

Hello, doctor.
My question is: (1) I had a car accident 20 years ago where I hit my head.
At that time, there was no significant injury, but I have a noticeable lump on the upper left side of my head, above the ear.
When I touch it, I can feel a small mass.
In the past, I would experience pain occasionally, but recently, the pain has become more frequent, occurring 2-3 times a week.
The pain is mostly on the left side of my head and is accompanied by a slight feeling of nausea and loss of appetite.
I feel mentally unwell and often feel sleepy; no matter how much I sleep, I still feel tired.
I also experience general discomfort, particularly in my lower body, with noticeable swelling in both legs from the thighs to the calves.
The swelling is more pronounced daily and only slightly reduces during sleep.
After getting up, the swelling returns within 3-4 hours.
I have seen specialists in nephrology, diabetes, and endocrinology, and all tests came back normal.
Please help me with this issue.
Thank you.

julia, 40~49 year old female. Ask Date: 2006/09/27

Dr. Cai Jueren reply Family Medicine

Hello, the symptoms you described are likely a type of migraine.
Migraines often have no identifiable cause and are usually managed with pain relief medications.
I recommend that you first visit a major hospital's sleep center to address any sleep issues, as resolving these may alleviate your headache problems.
If your sleep improves but the headaches persist, then you should consult a neurologist.
Thank you for your inquiry, and I hope the above suggestions help resolve your concerns.
Dr.
Tsai Jue-Ren, Hualien Hospital.

Reply Date: 2006/09/27

More Info

Chronic headaches can be a complex issue, especially when they are accompanied by other symptoms such as nausea, fatigue, and swelling in the lower extremities. Given your history of a head injury from a car accident 20 years ago, it is essential to approach this situation with careful consideration of both your past and present symptoms.

Firstly, it is important to understand that headaches can arise from various causes, including tension-type headaches, migraines, cluster headaches, and secondary headaches due to underlying medical conditions. In your case, the fact that you have a history of head trauma could suggest the possibility of post-traumatic headaches, which can develop after an injury and may persist for years. These headaches can vary in intensity and frequency and may be exacerbated by stress, lack of sleep, or other environmental factors.

The symptoms you describe—persistent headaches primarily on the left side of your head, feelings of nausea, and a general sense of malaise—warrant a thorough evaluation by a specialist. Given the complexity of your symptoms, I would recommend consulting a neurologist. Neurologists specialize in disorders of the nervous system, including headaches, and can provide a comprehensive assessment to determine the underlying cause of your chronic headaches.

During your consultation, the neurologist may perform a detailed medical history and physical examination, focusing on your headache patterns, triggers, and associated symptoms. They may also recommend imaging studies such as an MRI or CT scan to rule out any structural abnormalities in the brain that could be contributing to your headaches. Additionally, they may inquire about your sleep patterns, stress levels, and any medications you are currently taking, as these factors can significantly influence headache frequency and intensity.

It is also worth noting that your symptoms of lower extremity swelling and fatigue could be related to other medical conditions. While you have mentioned that you have seen specialists for kidney, diabetes, and thyroid issues, it may be beneficial to follow up with a vascular specialist or a rheumatologist if the swelling persists. Conditions such as venous insufficiency or autoimmune disorders can lead to swelling and discomfort in the legs, which may be contributing to your overall sense of unwellness.

In the meantime, managing your headaches may involve lifestyle modifications, such as maintaining a regular sleep schedule, managing stress through relaxation techniques, and staying hydrated. Over-the-counter pain relievers like acetaminophen or NSAIDs may provide temporary relief, but it is crucial to use them judiciously to avoid medication overuse headaches.

In summary, given your chronic headaches and accompanying symptoms, I strongly recommend consulting a neurologist for a thorough evaluation. They can help identify the underlying causes of your headaches and develop an appropriate treatment plan tailored to your needs. Additionally, addressing any other health concerns, such as the swelling in your legs, with the appropriate specialists will be essential in managing your overall health and well-being.

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