Assessment and management of headache and dizziness in neurology

Headache and dizziness are among the most common symptoms encountered in neurological practice. Although often benign, they can significantly impact quality of life and occasionally signal serious underlying pathology. A structured, clinically focused approach is essential to ensure accurate diagnosis and effective management.

Headache disorders are broadly classified as primary or secondary. Primary headaches, including migraine, tension-type headache and cluster headache, account for the majority of cases seen by neurologists. Migraine in particular is highly prevalent and frequently underdiagnosed. It may present with unilateral throbbing pain, photophobia, phonophobia, nausea and, in some cases, aura.

Chronic migraine can be especially disabling and often requires a combination of lifestyle modification, acute therapies and preventive treatments, including anti-CGRP monoclonal antibodies or botulinum toxin in selected patients.

Secondary headaches must always be considered, particularly in the presence of red flag features such as sudden onset (“thunderclap” headache), new headache in patients over 50, focal neurological deficits, systemic symptoms, or a change in established headache pattern. Neuroimaging and further investigations may be required to exclude causes such as intracranial haemorrhage, mass lesions, infection or raised intracranial pressure.

Dizziness is an equally complex symptom, encompassing vertigo, presyncope, disequilibrium and non-specific light-headedness. Careful history-taking is crucial to distinguish peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis, from central causes including cerebellar stroke, multiple sclerosis or vestibular migraine. Examination of eye movements, coordination and gait plays a key role in localisation.

For neurologists, the challenge lies not only in excluding serious disease but also in providing clear explanations and tailored management plans. Early specialist assessment can improve diagnostic accuracy, reduce unnecessary investigations and deliver targeted treatment, ultimately improving patient outcomes and quality of life.