A working diagnosis on day one. A treatment answer in three months.

THE PRACTICAL SIDE · TIMELINE

A headache workup gives a working diagnosis at the first visit, a confirmed one within a few weeks, and a treatment answer over two to three months. People expect a diagnosis on day one and a cure by week two, and knowing the real shape in advance is what stops them abandoning a plan that was working.

What happens at each stage of a headache workup?

Why does headache treatment take months to judge?

Two reasons, both structural. Preventive medications need time at an adequate dose to show their effect, and headache frequency is naturally variable month to month, so a short window cannot distinguish a treatment effect from an ordinary good two weeks. Both are arguments for counting rather than impressions.

The exception is diagnostic: a nerve block answers its question the same afternoon. That speed is one of the reasons it is worth doing early rather than last.

What slows down a headache workup?

Turning up without the counts, so visit one produces a plan to start counting instead of a plan to treat. Stopping a preventive at week three for a side effect that would have settled. And judging everything on top of an unaddressed overuse layer, which makes every option look like a failure and can add months.

There is a fourth factor that is not clinical: a working pattern that makes the behavioral half impossible. A plan that cannot be executed in your actual week does not fail slowly, it fails invisibly, which is why we ask about the roster.

Frequently asked questions

Will I get a diagnosis at the first appointment?

A working diagnosis, usually yes. A confirmed one may need a diagnostic block, which is a separate short appointment.

The first visit is mostly talking, then an examination, which almost nobody expects. What happens at a headache clinic goes through it in detail.

How long before I feel better?

Some people improve within weeks, particularly if an overuse layer is the main driver. A fair assessment of an oral preventive is 8 to 12 weeks.

Can I speed it up?

Yes — arrive with two weeks of diary and the doses and durations of what you have tried. That alone often saves a visit. What to bring.

What if nothing works?

Then the diagnosis is revisited rather than the drug list extended. That is what a second opinion is for.

Preparation pages

• The diary
• What to bring
• What to ask
• What may be tried
• Coverage