Quick Answer
Migraine is managed by a neurologist, who classifies the disorder and manages preventive treatment. Primary care is a sensible first stop and frequently sufficient. Sudden or severe presentations need an emergency department rather than any appointment. Bring your referral, insurance card and any prior imaging reports to the first visit.
Part ofThis guide sits beneath headache and migraine, which covers the study itself, how it is performed and what the report should contain.
Headache and Migraine →Key Takeaways
- Neurology classifies the headache disorder, which is the step that determines everything after it.
- Primary care handles the reversible contributors and manages many headache disorders without referral.
- A headache peaking within seconds, or with fever, weakness or vision loss, needs an emergency department.
- Jaw pain with clicking or restricted opening is a dental or jaw-joint question rather than neurology.
- Describing the symptom rather than requesting a specialty is the faster route in.
Migraine
Migraine is a neurological disorder in which attacks of head pain occur alongside other nervous-system symptoms such as nausea, light or sound sensitivity, and visual aura. It is a disorder of how the brain processes sensory input, not simply a bad headache.
Which clinician treats this, and why the routing matters
Headache is managed across several specialties and the boundaries are genuinely unclear to patients, which produces misdirected appointments and lost weeks.
Where neurology fits
Neurology classifies the headache disorder, which is the step that determines everything after it, and manages preventive treatment including the in-office options. Classification matters because the treatment approaches for migraine, tension-type headache and cluster headache barely overlap, and a patient treated for the wrong one frequently receives a medication that was never likely to help.
Where primary care fits
A sensible first stop, and frequently sufficient. It handles the reversible contributors worth excluding early, including thyroid function, vitamin B12 and glucose, along with a medication review, and it manages many headache disorders effectively without referral. Where a plan requires a referral before specialist cover, that originates there.
Where it is not neurology at all
A headache reaching maximum intensity within seconds, or with fever and neck stiffness, new weakness, difficulty speaking or vision loss, needs an emergency department rather than any appointment. Recurrent facial pressure genuinely caused by sinus disease belongs with an ENT specialist, though it is frequently migraine instead. Jaw pain with clicking or restricted opening is a dental or jaw-joint question. And this practice runs no interventional pain programme, so procedures beyond nerve blocks are referred.
What speeds it up
Describing the symptom rather than requesting a specialty, because the practice routes by clinical question. And bringing a month of dates, since classification depends on frequency and pattern rather than on how the pain is described.
| Also considered | How it is distinguished |
|---|---|
| Tension-type headache | Pressing, bilateral pain without nausea, aura or movement sensitivity. |
| Cluster headache | Strictly one-sided, 15 minutes to about 3 hours, with tearing, nasal congestion or a drooping eyelid, and restlessness rather than stillness. |
| Medication-overuse headache | A pattern change: headaches become more frequent as acute medication use rises, and the history rather than a scan identifies it. |
| Secondary headache | Red flags — sudden 'worst-ever' onset, fever with neck stiffness, new deficit, or onset after head injury — prompt urgent imaging rather than a headache diagnosis. |
What the practice does, and what to bring
01
What brings people in
Frequent or changing headaches, attacks that are no longer controlled by what used to work, or a new headache pattern that needs an explanation.
02
What the evaluation settles
Which headache disorder the pattern fits, whether any red flag needs imaging, and which preventive and acute options are appropriate.
03
What you leave with
A named diagnosis where one can be made, a written acute and preventive plan, and a follow-up interval to judge whether it is working.
Bring a month of dates
Which days you had a headache, roughly how severe, and what you took. That single record converts an approximate conversation into a decision, and its absence is the commonest reason a first appointment ends with a request to return.
Medication overuse checked before a preventive is added
Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. Common, not a failure of willpower, and it changes the plan: addressing it usually has to come before or alongside a new preventive, because a preventive started on top of an unrecognised overuse pattern works against a headwind.
Treatment options performed here
Botox for chronic migraine and CGRP therapy are both available, on the Botox page and the CGRP page. Where pain localises to a specific nerve on examination, a targeted nerve block may apply. Coverage and prior authorisation are completed before the appointment.
How prevention is assessed
On the change in headache frequency across months rather than on whether it stopped one attack. Abandoning a preventive after two weeks is the commonest way a workable plan gets discarded before it has been tested. Practice guidance is from the American Academy of Neurology.
The first 30, 60 and 90 days
Step 1
First visit
History and neurological examination, a review of records and prior imaging, and a decision on which studies are actually indicated. You leave with the plan, not just a referral.
Step 2
Within 30 days
Indicated in-office studies are performed and interpreted by the neurologist who ordered them, in our AANEM-accredited laboratories. Results are explained in plain language.
Step 3
60 to 90 days
Follow-up to judge whether the plan is working, adjust it, and coordinate with your referring clinician. Where a diagnosis needs time to confirm, this is where it is revisited.
Not sure which headache type you have?
Bring a month of dates and what you took. Classification comes before treatment.
The Bottom Line
Neurology classifies and prevents; primary care handles much of the rest; sudden or severe goes to an emergency department. Describing the symptom routes you faster than naming a specialty.
Frequently Asked Questions
What counts as chronic migraine?
Fifteen or more headache days a month, with migraine features present on at least eight of them. It is a numerical definition rather than a description of severity, and it determines candidacy for several preventive treatments. Episodic migraine, meaning fewer than fifteen headache days a month, is managed differently, so establishing which side of that line you sit on changes which options are open to you.
Why does frequency matter more than severity?
Because treatment decisions run on how many days a month are affected rather than how bad the worst day was. Most people underestimate their count substantially when reconstructing from memory, which is why a month of dates is worth more than any description. A written record of dates is the only thing that settles the count reliably.
Could my sinus headaches be migraine?
Frequently. Migraine activates a pathway producing nasal congestion, facial pressure and tearing, which are exactly the symptoms people attribute to sinuses. Recurrent sinus headache without infection is uncommon, so episodic attacks with clear intervals point toward migraine. Sinus imaging in these patients is frequently normal, and that is often the point at which migraine is finally considered.
Can painkillers make my headaches worse?
Yes. Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. It is common and not a failure of willpower, but addressing it usually has to come before or alongside a new preventive. The pattern to watch for is acute medication on more than about ten days a month, sustained across several months.
Should I see a neurologist or my primary care physician first?
Primary care is a sensible first stop and frequently sufficient, and it handles the reversible contributors worth excluding early. Neurology adds classification of the disorder and management of preventive treatment including the in-office options. A referral is not always required, though some plans ask for one, and our team checks that before the visit.
When is it not a headache specialist question at all?
When a headache reaches maximum intensity within seconds, or comes with fever and neck stiffness, new weakness, difficulty speaking or vision loss. Those need an emergency department. Jaw pain with clicking is a dental or jaw-joint question. Eye pain with visual change is an ophthalmology question, and both are worth excluding before a headache work-up begins.
Can I be treated if imaging has already been done and was normal?
Yes, and a normal scan is the expected finding in migraine. Imaging looks for a structural cause; it does not diagnose or exclude a headache disorder, which is established from the pattern. Bring the report rather than repeating the scan, because knowing it was normal changes what still needs considering.
Will I have to stop the medication I am using now?
Not abruptly, and not without a plan. Where an acute medication is being taken often enough to be sustaining the headaches, reducing it is planned deliberately alongside starting a preventive, because doing one without the other usually fails. Bring the bottles so the actual pattern can be seen rather than estimated.
How many headache days should I record before coming in?
A month is ideal and two weeks is useful. Record the date, roughly how bad it was, and what you took including anything bought without a prescription. That record is what establishes frequency, and frequency rather than severity decides which treatments are open to you, so it does more work than any description can.
How long does a first appointment take?
Longer than a routine primary care visit, because most of it is history taking and that is the part carrying the diagnosis. A physical examination follows. Allow rather more time in your day than the slot itself suggests, since it is better not to be watching the clock during the examination or the explanation afterwards.
How this page was sourced
Practice facts come from Clinical Neurology Specialists directly: that Botox for chronic migraine and CGRP therapy are both available in-office, and that the practice performs no cosmetic injections and runs no interventional pain programme. Clinical context is sourced to the organisations listed below.
No named agents, response rates, reduction percentages or dosing appear, because selection is a clinical decision and response varies between individuals. Treatment approaches are described by class and mechanism rather than by product. No outcome is promised. Scope is adults 18 and older.
Change log
- 2026-07-28 — page published; clinical content reviewed.
- 2026-07-28 — last reviewed against AAN, AANEM and NINDS guidance; internal links and schema verified.
- Review cadence: quarterly, or sooner if guidance changes.
How to cite this page
Clinical Neurology Specialists. “What doctor treats migraine.” Reviewed 2026-07-28. https://www.cnsnevada.com/conditions/headache-migraine/what-doctor-treats-migraine/
References
- American Headache Society — classification and clinical guidance for headache disorders.
- American Academy of Neurology — practice guidance on preventive treatment.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
This page is for general information about a Clinical Neurology Specialists office and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department.