Migraine and headache: when to see a specialist
Headaches are among the most common reasons people see a doctor. Most are not dangerous, but recurring headaches can disrupt work and sleep, and a few need urgent care. Knowing the difference helps you decide what to do.
Migraine and tension-type headache
| Migraine | Tension-type headache | |
|---|---|---|
| Typical pain | Throbbing or pulsating, often on one side | Pressing or tight band, often both sides |
| Severity | Moderate to severe | Mild to moderate |
| Other symptoms | Nausea, sensitivity to light and sound | Usually none |
| Effect of activity | Often worse with movement | Usually not affected |
Some people with migraine have an aura before or during the headache, most often visual changes such as zigzag lines or blind spots, lasting minutes. Neck and shoulder muscle tension, common with office syndrome, can also contribute to headaches.
Common triggers
Triggers vary from person to person. Frequently reported ones include missed meals, too little or too much sleep, stress or the release after it, hormonal changes, alcohol, dehydration and strong light or smells. A headache diary over several weeks can help you and a doctor spot patterns.
Treatment
Acute treatment
This aims to stop an attack. It includes simple pain relievers and anti-inflammatory medicines, anti-sickness medicines and migraine-specific medicines such as triptans, which need a prescription. Using pain medicines on many days each month can itself cause more frequent headaches, known as medication-overuse headache.
Preventive treatment
For frequent or disabling migraine, doctors may suggest daily preventive medicines, newer injectable treatments that target a protein called CGRP, or botulinum toxin injections for chronic migraine. Sleep, regular meals, exercise and managing stress also play a part.
Warning signs: get emergency care
Call 1669 or go to an emergency department for a sudden, very severe headache that peaks within a minute; a headache with fever and a stiff neck; headache with weakness, numbness, confusion, difficulty speaking or loss of vision; a headache after a head injury; or a new, different headache in someone over 50, during pregnancy, or with a weakened immune system.
When to see a neurologist
Consider seeing a neurologist if headaches are frequent, are changing in pattern, do not respond to treatment, or come with other neurological symptoms such as numbness or sleep problems. Some hospitals in Bangkok run dedicated headache clinics within their neurology departments.
Written by the SurgicalEyes editorial team. Last updated October 2026. See how we prepare and check guides in our medical review policy.