WHEN IT IS WORTH GETTING ONE
A second opinion for headaches is not a criticism of the first. It is what you do when the plan has stopped changing and the headaches have not.
Five situations where it earns its place
- Two or more preventives have failed at adequate dose and duration. That is the usual trigger. The key word is adequate — incomplete trials do not count.
- Nobody has counted with you. If no one has ever pinned down your headache days and medication days, no plan built without them can be judged.
- Nobody has examined your neck. An exam of the neck and the back of the head (cervical and occipital) takes minutes. It is skipped all the time. It is the most common gap we find.
- The plan has only one half. Years of more and more acute (attack) treatment with no talk of prevention is a gap built into the plan, not bad luck.
- Something has changed and the explanation has not. A clear change in pattern deserves fresh eyes.
What a useful second opinion actually does
Not just prescribe the next drug on a list. It should take the history again from the start, pin down the two numbers, and examine you. Then it should say plainly whether the working diagnosis still fits the evidence. Sometimes the answer is that the diagnosis was right and the trials were incomplete. That is a genuinely useful result, even though nothing new is added.
The most valuable thing a second opinion can produce is a changed diagnosis. The most common changes are the same three. An overuse layer nobody counted. A neck source nobody examined. Or a migraine that has been called sinus or tension for years.
What to bring, and what makes it worth the trip
Two weeks of diary. The list of every preventive, with the dose, how long you took it and why it stopped. Imaging reports. And your current medication list, including over-the-counter products. Without the doses and how long each was taken, a second opinion is mostly guessing at what has already been tried. The full list.
You do not have to leave anyone
Headache care is not a loyalty test. A neurologist can manage the disorder while a pain physician holds the floor with blocks during a hard stretch. That is a normal setup, not a conflict. We will write to whoever else is involved. How the two roles differ.
Frequently asked questions
Will my doctor be offended?
A reasonable doctor expects second opinions in a condition that varies this much, and often welcomes them. You do not need permission. You do not need to explain yourself.
Do I need a referral?
No. You can book directly here.
What if the second opinion agrees with the first?
That is a real result. Knowing the diagnosis held up under a fresh look changes how you approach the next treatment.
How do I know if my drug trials were adequate?
Ask whether each one reached a dose that works and ran 8 to 12 weeks. Anything shorter is incomplete — why that matters.
Bring these with you
When the plan stops changing and the headaches do not
That is the moment. Bring the doses and the durations and we will start from the history.
12174 Natural Bridge Rd, Suite 304
St. Louis, MO 63044
Next to DePaul Hospital, off the I‑270 and I‑70 junction, west of the airport.
Sources
- Tram J et al. Interdisciplinary Headache Management. Physical medicine and rehabilitation clinics of North America, 2025. PubMed 41167859
- Steiner TJ et al. Aids to management of headache disorders in primary care (2nd edition) : on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. The journal of headache and pain, 2019. PubMed 31113373
- Haghdoost F et al. Evaluating the efficacy of CGRP mAbs and gepants for the preventive treatment of migraine: A systematic review and network meta-analysis of phase 3 randomised controlled trials. Cephalalgia : an international journal of headache, 2023. PubMed 36855951
- Pohl H. Red flags in headache care. Headache, 2022. PubMed 35167120