Most headaches are benign. Medication overuse is the cause more often than anyone expects.
Assessed and treated by a GMC-registered GP
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Almost everyone gets headaches, and the overwhelming majority are primary headaches — the headache is the condition, not a symptom of something else. Tension-type headache and migraine account for most of them.
A small minority are secondary — caused by something identifiable, occasionally something serious. The purpose of a consultation is to sort one from the other, which a careful history does reliably and which is why this assesses well remotely.
Three things are worth flagging at the outset, because each is common, treatable, and repeatedly missed:
One-sided, throbbing, moderate to severe, worse on movement, with nausea and dislike of light and sound. Disabling. See migraine for the full picture.
It is far more common in men, and the average time to correct diagnosis is measured in years. If this describes your headaches, say so explicitly — there is specific treatment that works.
Present on most days, usually there on waking, in someone taking painkillers regularly. Often started as migraine or tension headache and became daily.
Headache is diagnosed by history. There is no test for primary headache, and scanning is normal — which means imaging cannot make the diagnosis and is only useful for excluding specific concerns.
Four to six weeks of dates, timing, duration, severity, medication taken and cycle position. It is the most useful investigation available for headache, costs nothing, and repeatedly shows patterns — particularly medication overuse — that nobody had recognised.
Not for typical primary headache with a normal examination. It is warranted for a thunderclap onset, new headache over 50, a clear change in an established pattern, headache worse lying flat or on straining, persisting neurological symptoms, or new headache in someone immunosuppressed or with a cancer history.
Inflammatory markers urgently where temporal arteritis is suspected; full blood count and thyroid function where the picture is unclear.
Headache is well suited to remote assessment — diagnosis is by history, and treatment is a conversation and a prescription. What we cannot do is a neurological examination or fundoscopy, so where the history raises concern we arrange in-person assessment rather than working around it.
Ordinary painkillers are useless here — attacks peak before a tablet could work. The treatments that do work:
If your description fits cluster headache, we refer to neurology — and we say so clearly, because being told for years that it is sinusitis is a common and avoidable experience.
The treatment is withdrawal of the overused painkiller. That means a genuinely difficult two to four weeks in which headaches worsen before improving markedly.
It is far more achievable with a plan, a defined start date, a preventive started alongside, and someone to check in with. We will not simply tell you to stop — we will set it up properly, because doing it unsupported is where most attempts fail.
Neurology referral for cluster headache, diagnostic uncertainty, headaches not responding to two adequate preventives, or any red-flag feature.
Call 999 for:
Seek same-day assessment for:
Book a routine consultation if: headaches occur on more than a few days a month; you take painkillers on more than 10 days a month; headaches disturb sleep, work or family life; or your description fits cluster headache. All of these have treatments.
Do not take painkillers on more than 10 days a month. Above that, they cause headaches rather than treating them. Track it honestly — people routinely under-count, because a tablet taken at work does not feel like a dose.
Avoid codeine-containing painkillers for headache entirely. They are the most likely to cause medication overuse headache and the hardest to withdraw from.
If you get headaches at home that ease when you go out, or others in the household have them too, have your gas appliances checked and fit a carbon monoxide alarm. They cost very little. This is uncommon but it kills people, and the pattern is the only clue.
The most valuable and least welcome thing about frequent headaches is free: the painkillers may be causing them.
Medication overuse headache develops when painkillers are taken on 10 to 15 days a month or more — and it is common, under-recognised, and produces exactly the pattern people describe as chronic daily headache. The treatment is stopping the painkillers, which makes things worse for a few weeks before it makes them better, and almost nobody attempts it without being told what to expect.
Simple analgesia and a headache diary cost almost nothing, and the diary is genuinely the most useful diagnostic tool here — more so than any scan.
Your NHS GP treats headache free, and NHS neurology is free on referral.
Private brain imaging is heavily marketed for headache and is rarely indicated. NICE recommends against neuroimaging solely for reassurance in people with a normal examination and no red flags — the diagnostic yield is very low, and incidental findings generate their own anxiety and investigation.
Where a consultation is genuinely worth paying for is getting the diagnosis right — tension-type, migraine, cluster and medication overuse are managed completely differently — and reviewing whether preventive treatment is warranted.
What needs emergency assessment: a sudden severe headache reaching peak intensity within minutes; headache with fever, neck stiffness or rash; headache with weakness, confusion or visual loss; new headache after 50; or headache worse lying down, on coughing, or first thing in the morning.
NICE CG150, Headaches in over 12s: diagnosis and management, is the governing guideline. It sets out diagnostic criteria for tension-type headache, migraine, cluster headache and medication overuse headache, and recommends a headache diary for at least eight weeks to support diagnosis.
CG150 defines medication overuse headache as occurring with use of triptans, opioids or combination analgesics on 10 or more days a month, or simple analgesics on 15 or more days a month, and recommends abrupt withdrawal with warning that symptoms worsen initially.
CG150 recommends against neuroimaging solely for reassurance in people with a normal neurological examination.
CG150 lists the red flags requiring urgent or emergency assessment, which underpin the features above.
NICE NG12 covers headache features warranting urgent brain imaging for suspected malignancy.
Almost certainly not. Primary headaches — tension-type and migraine — are diagnosed on history, and a scan is normal in both, so it cannot confirm anything. Scanning is reserved for specific warning features. A normal scan also does not make headaches less real, which is a common and unhelpful assumption.
Three possibilities are worth checking. Medication overuse is the commonest — count your painkiller days honestly. Sleep apnoea causes morning headaches, particularly with snoring and daytime sleepiness. And rarely, headache worse on waking and on lying flat can indicate raised pressure inside the head, which needs assessing.
Yes, and it is one of the most under-recognised problems in headache medicine. Regular use — more than 10 days a month — changes how the brain processes pain and produces a persistent daily headache. The only treatment is stopping, which is hard for two to four weeks and then markedly better.
Less often than people assume, but it is worth excluding, particularly if headaches follow close work or reading and sit around the eyes and forehead. An eye test is quick, often free, and rules it in or out.
Usually not. High blood pressure does not generally cause headaches unless it is very high indeed, and the belief that it does leads people to check their blood pressure when they have a headache — finding it raised because they are in pain and anxious. It is worth measuring, but it rarely turns out to be the explanation.
Three features together: excruciating one-sided pain around the eye, lasting under three hours, with a watering eye or blocked nostril on that side — and, crucially, being unable to keep still. Migraine sufferers lie down; cluster sufferers pace. If that is you, say so, because the treatment is completely different and highly effective.
Worth taking seriously if headaches occur at home and improve when you are away, particularly if anyone else in the house — including pets — is affected. Get gas appliances serviced and fit an alarm. It is rare, but it is one of the few headache causes that is both entirely preventable and fatal.
Both. It can relieve a headache in the short term and cause one on withdrawal. What matters is consistency — a steady daily amount is fine, while cutting back sharply on a Saturday produces exactly the weekend headache people blame on stress.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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