What actually happens at a headache clinic

After months on a waiting list, a first headache clinic appointment can feel like a lot rides on it. Knowing what usually happens helps you get the most from it.

Who you'll see

NHS headache clinics are usually run by a neurologist with a special interest in headache. You may instead see a headache specialist nurse or a GP with extra training in headache. Some clinics also have specialist pharmacists who manage newer treatments. All of them work to the same national guidance, and they can bring in the consultant when needed.

Your appointment may be face to face, by phone or by video. First appointments are usually in person, because they often include an examination.

The questions you'll be asked

Most of the appointment is spent talking. Headache disorders are diagnosed mainly from your story, so expect detailed questions such as:

• when your headaches started and how they've changed
• how often they happen, how long they last and what they feel like
• other symptoms, such as nausea, sensitivity to light or aura
• every medicine you've tried, the dose, how long you took it and why you stopped
• how many days a month you take pain relief
• sleep, mood, caffeine, periods and anything else that seems to make a difference
• how headaches affect your work, family and daily life

You may also be asked to fill in a short questionnaire about how much headaches affect you. It's used to measure change over time.

The medication questions matter most, and they're the hardest to answer from memory. A preventive that "didn't work" after two weeks at a low dose hasn't really been tried. Your specialist needs to know that. A diary kept in the weeks before the appointment answers most of these questions for you.

Arrive with the answers.The free Migrevention diary builds a summary of your headache days, medicines and symptoms you can show at your appointment.

Get the free diary

The examination

The specialist will usually check your nervous system: reflexes, strength, coordination, eye movements and sensation. They'll often look at the back of your eyes with a light and check your blood pressure. It's quick and painless, and in most people it's normal. A normal examination is one of the things that makes a serious cause unlikely.

Will I have a scan?

Probably not. If your symptoms fit a clear headache pattern and your examination is normal, a scan won't change the treatment, and NICE advises against scanning for reassurance alone. If something in your history or examination doesn't fit, the specialist will arrange one and explain why.

What you'll usually leave with

Most first appointments end with:

• A clear diagnosis, such as migraine, chronic migraine, medication overuse headache or a less common headache disorder.
• A plan, often in steps. It may include cutting back on painkillers, changing how you use triptans or starting a preventive at a dose that will be increased gradually.
• Specialist treatment where you're eligible. This might be a nerve block (an injection at the back of the head that can calm frequent headaches for weeks), Botox for chronic migraine or an anti-CGRP medicine.

Most medicines will be prescribed by your GP, following the clinic's advice. Some specialist treatments are supplied through the hospital.

What happens next

The clinic writes to your GP with the diagnosis and plan, and you should also get a copy of the letter. Ask for one if it doesn't arrive. Keep it: it's the clearest record of what's been tried and what comes next.

You may be offered a follow-up after a few months, often by phone or with a specialist nurse, to see whether the plan is working. Or you may be discharged back to your GP with a plan to follow. Discharge doesn't mean the door is closed. If things don't improve, your GP can ask the clinic for advice or refer you again.

Before you go, write down:

• the two or three things you most want to change
• your questions, such as "What should I try if this doesn't work?" and "Who do I contact if I have side effects?"

It's easy to forget things in the room. Having them written down makes sure the appointment covers what matters to you.

Sources: NICE CG150, Headaches in over 12s: diagnosis and management. NICE TA260, Botulinum toxin type A for chronic migraine. NICE TA973, Atogepant for preventing migraine. British Association for the Study of Headache (BASH), National headache management system for adults.