Migraine, dizziness, numbness: when should you see a neurologist?

Neurology Without Myths: 15 Important Questions for a Neurologist

Headaches, migraine, dizziness, numbness in the limbs, neck and back pain, and sleep disturbances are symptoms experienced by millions of people. Yet many continue to tolerate their discomfort, take painkillers on their own, or postpone seeing a doctor.

According to the World Health Organization, in 2021, diseases and conditions affecting the nervous system affected approximately 3.4 billion people — around 43% of the global population. Neurological conditions are also among the leading causes of ill health and disability worldwide.

Which symptoms should never be ignored? How is migraine different from an ordinary headache? Is a herniated disc always responsible for back pain? When is an MRI really necessary?

These common questions are answered by Nigora Saidganievna Kadyrkhodjaeva, an AKFA Medline neurologist with 19 years of clinical experience, MD, PhD. Her professional interests include neurology, neuropsychology, transcranial magnetic stimulation (TMS), and the use of botulinum toxin therapy in neurology, including the treatment of primary chronic headaches.

1. What are the most common reasons patients consult a neurologist?

The most common complaints include headaches, dizziness, neck and back pain, numbness or tingling in the arms and legs, muscle weakness, sleep disturbances, and memory problems. Patients may also seek neurological care for tremor, impaired coordination, tinnitus, changes in sensation, various pain syndromes, consequences of stroke, and conditions affecting the peripheral nervous system. It is important to understand that the same symptom can have very different causes. For example, dizziness may be associated with the vestibular system or may occur as a manifestation of other medical conditions. A neurologist’s task is therefore not simply to relieve the symptom but to identify its underlying cause.

2. Which neurological symptoms do people most often underestimate or ignore?

Particular attention should be paid to sudden numbness or weakness in an arm or leg, especially on one side of the body, speech disturbances, facial asymmetry, sudden visual impairment, an unusually severe headache, and sudden loss of coordination. People also frequently ignore recurring headaches, intermittent numbness in the fingers, balance problems, back pain radiating into an arm or leg, memory problems, and sleep disturbances. If a symptom keeps returning, becomes progressively worse, or begins to interfere with daily life, it should not simply be tolerated. A medical assessment is necessary.

3. When does an ordinary headache become a reason to see a neurologist?

If headaches occur regularly, become more severe, or change from their usual pattern, the cause should be investigated.

It is particularly important to seek medical advice if:

• the headache is new and unusually severe;

• attacks are becoming more frequent;

• the pain is accompanied by vomiting, visual or speech disturbances, sensory changes, or weakness;

• the headache follows a head injury;

• painkillers are required too frequently;

• headaches interfere with work, sleep, or everyday activities.

A sudden, extremely severe headache that reaches maximum intensity within seconds or minutes is an important warning sign and requires urgent medical evaluation.

4. What is migraine, and how is it different from an ordinary headache?

Migraine is a neurological disorder in its own right, not simply a “very bad headache.” A typical migraine attack can last from several hours to several days. The pain is often throbbing, may be more pronounced on one side of the head, and can worsen during ordinary physical activity. Migraine headaches are often accompanied by nausea and increased sensitivity to light, sound, and smells. However, not every patient has the classic presentation. Diagnosis is therefore based primarily on the characteristic symptoms and the patient’s medical history.

5. What symptoms are typical of migraine, and what commonly triggers an attack?

In addition to headache, patients may experience:

• nausea;

• increased sensitivity to light and sound;

• irritability;

• difficulty concentrating;

• significant fatigue;

• worsening symptoms with physical activity.

Migraine triggers vary from person to person. Common triggers include too little or too much sleep, emotional stress, skipping meals, dehydration, certain hormonal changes, and sudden changes in daily routine. Keeping a headache diary can be very useful. Patients can record when an attack occurred, how long it lasted, possible triggers, associated symptoms, and medications taken. This helps the physician identify patterns and choose the most appropriate treatment strategy.

6. What is migraine with aura, and how does it present?

Aura consists of temporary, reversible neurological symptoms that most commonly occur before the headache, although they may sometimes occur without a subsequent headache. Visual aura is the most common type. A person may see flashing spots, zigzag lines, flashes of light, or temporary blind spots in the visual field. Sensory symptoms are also possible, such as tingling or numbness that gradually spreads along the arm or face. Temporary speech disturbances occur less commonly. If these symptoms occur for the first time, particularly if they develop suddenly, they should not automatically be assumed to be migraine. Some manifestations can resemble a transient ischemic attack or stroke, so medical evaluation is important.

7. Can migraine be treated, and what modern treatments are available today?

Migraine can be effectively managed with modern treatment. The main goals are to reduce the frequency, duration, and intensity of attacks and to improve the patient’s quality of life. Treatment generally has two components. The first is acute treatment, aimed at stopping or reducing an attack once it begins. Depending on the situation, a physician may prescribe migraine-specific medications or other appropriate treatments. The second is preventive therapy. This may be considered when attacks are frequent, prolonged, or significantly affect the patient’s daily life. Botulinum toxin therapy may be used in selected patients with chronic migraine. Modern neurology also offers newer preventive therapies that target biological pathways involved in migraine development. The choice of treatment depends on the frequency of attacks, associated medical conditions, previous treatment, and the patient’s individual characteristics.

8. Is a brain MRI necessary for frequent headaches or migraine?

Not every person with headaches needs an MRI. If the clinical picture is typical of a primary headache disorder such as migraine, and the neurological examination does not reveal any warning signs, additional imaging may not be necessary. MRI is usually recommended when the physician needs to rule out a secondary cause of headache — for example, when the pattern of pain has changed, neurological symptoms have appeared, the clinical picture is unusual, or other concerning signs are present. The appropriate sequence is therefore to have a clinical consultation and neurological examination first, followed by diagnostic testing when indicated.

9. What causes dizziness, and when can it be a warning sign?

Patients may use the word “dizziness” to describe very different sensations: a spinning feeling, instability, loss of balance, near-fainting, or a sensation of “brain fog.” The causes are equally varied. One common cause is benign paroxysmal positional vertigo, in which symptoms are triggered by changes in head position. Other causes may involve the inner ear, nervous system, cardiovascular system, or other medical conditions. If dizziness begins suddenly and is accompanied by speech disturbance, weakness or numbness in the limbs, double vision, severe loss of coordination, or a new intense headache, urgent medical attention is required.

10. What can numbness, tingling, or a “pins and needles” sensation in the arms and legs indicate?

These sensations can have many different causes, ranging from temporary compression of a nerve to disorders affecting the spine, peripheral nerves, or central nervous system. For example, numbness in the hand may result from compression of a particular nerve, while symmetrical numbness in the feet may occur in peripheral neuropathy. The physician assesses exactly where the numbness occurs, how severe it is, and whether it is associated with pain, muscle weakness, or changes in reflexes. Medical evaluation should not be delayed if sensory changes are progressive or accompanied by muscle weakness.

11. What early signs of stroke should everyone know?

The most important feature of stroke symptoms is that they usually appear suddenly. Face: Ask the person to smile. One side of the face may droop. Arm: Ask the person to raise both arms. One arm may drift downward or may not be raised at all. Speech: Ask the person to repeat a simple sentence. Their speech may become slurred, or they may be unable to speak correctly. Other symptoms can include sudden visual impairment, severe dizziness, loss of coordination, or numbness or weakness on one side of the body. If stroke is suspected, do not wait to see whether the symptoms disappear. Emergency medical assistance should be called immediately. The sooner the patient reaches a specialized medical facility, the greater the opportunity for effective treatment.

12. Why are neck and back pain now common even among younger people? Is a herniated disc seen on MRI always the cause of pain?

No. Finding a disc protrusion or herniation on MRI does not necessarily mean that it is responsible for the patient’s pain. Changes in the intervertebral discs can also be found in people who have no pain at all. For this reason, a physician always interprets MRI findings together with the patient’s symptoms and the results of the neurological examination. Pain may arise from muscles, spinal joints, ligaments, irritation of neural structures, or other factors. Among younger people, a sedentary lifestyle, prolonged computer use, insufficient physical activity, inappropriate loading of the spine, and stress can all contribute to neck and back pain. The goal is to treat the patient and the actual cause of the symptoms — not simply an MRI image.

13. Can chronic stress, anxiety, and lack of sleep cause or worsen neurological symptoms?

Yes. Sleep, emotional wellbeing, and the nervous system are closely interconnected. Chronic stress and sleep deprivation can worsen headaches, migraine, muscle tension, dizziness, difficulty concentrating, and fatigue. Some patients develop a vicious cycle: stress disrupts sleep, poor sleep increases the sensitivity of the nervous system, symptoms become more intense, and this in turn increases anxiety. However, it is incorrect to attribute every symptom solely to stress without proper evaluation. Other possible medical causes should first be excluded.

14. What mistakes do patients most commonly make when self-treating headaches, migraine, or other neurological symptoms?

One of the most common mistakes is the uncontrolled and excessively frequent use of painkillers. When certain medications are used too often, headaches themselves can become more frequent, leading to what is known as medication-overuse headache. Another mistake is treating MRI findings instead of considering the patient’s actual clinical condition. Patients may also take medications “for circulation,” vitamins, sedatives, or other treatments without first establishing the actual cause of their symptoms. In neurology, an accurate diagnosis should come first. Treatment should then be selected according to that diagnosis.

15. What do you recommend for preventing neurological diseases and maintaining a healthy nervous system?

There is no single universal pill that can protect the nervous system from every neurological disease. Everyday habits have the greatest long-term importance.

It is important to:

• remain physically active;

• monitor blood pressure;

• monitor blood glucose and cholesterol levels;

• avoid smoking;

• maintain a regular sleep schedule;

• follow a balanced diet;

• avoid chronic sleep deprivation;

• avoid unnecessary or uncontrolled medication use;

• pay attention to psychological and emotional wellbeing.

Timely medical consultation is also extremely important. People should not wait until a symptom becomes unbearable. Recurrent headaches, sensory changes, severe dizziness, muscle weakness, and other neurological symptoms should be professionally assessed.

The key message: do not simply get used to symptoms

Headache, dizziness, or numbness does not always indicate a serious disease. However, it is not always possible to determine the cause without proper medical evaluation. In modern neurology, a diagnosis is not based on a single symptom or on an MRI result alone. The physician evaluates the patient’s complaints, medical history, and neurological status before deciding which additional investigations are actually necessary. If sudden weakness on one side of the body, facial asymmetry, speech or visual disturbance, or loss of coordination occurs, medical care should be sought immediately.

Timely diagnosis not only allows the correct condition to be treated but also helps prevent unnecessary investigations and inappropriate self-treatment.