When the pain won't let you live.

• A throbbing pain on one side of your head, lasting hours — sometimes a whole day
• Nausea, or sensitivity to light and sound, that arrives with the pain
• Headaches that return more than 4 times a month, year after year
• Painkillers from the chemist used to help, but don't anymore — or you've started needing them almost daily
• A tight, band-like pressure across the forehead, especially after long work hours or screen time
• Sharp, stabbing attacks behind one eye, sometimes waking you from sleep at the same time every night
• You've started avoiding plans, travel, or social events because you can't predict when the next attack will come

A migraine often arrives as a storm you can feel coming — a flicker in the vision, a strange smell, a heavy fog. By the time the pain hits, light feels like a knife and sound feels like a hammer. Tension headaches are quieter but persistent — a dull weight pressing across the forehead and into the neck that simply will not let go. Cluster headaches are different again: short, ferocious, almost always on one side and behind the eye, often arriving at the same hour every night.

Despite how it feels, the headache is rarely happening 'inside the brain' itself — the brain has no pain receptors. The pain comes from the blood vessels, nerves, and membranes surrounding the brain becoming irritated or inflamed. In migraine, a chemical called CGRP (calcitonin gene-related peptide) plays a central role — it's released during an attack and causes blood vessels to swell and nerves to fire pain signals. This is why the newer migraine treatments specifically target CGRP — they go after the cause, not just the pain. In tension headaches, it's often the muscles of the scalp and neck staying tight for too long, sometimes amplified by stress or poor posture. In cluster headaches, the hypothalamus — the brain's internal clock — seems to be involved, which explains why attacks often arrive at the same time each day. Knowing the type matters, because each one responds to genuinely different treatments.

Dr. Kumar's first goal is to identify exactly which type of headache you have — because the treatments are genuinely different. He starts with a detailed conversation about your headache pattern, your triggers, your sleep, your work, and what you've already tried. He then performs a focused neurological examination and rules out anything serious — an MRI is ordered only if there's a clinical reason, not as a routine. Most headache patients do not need an MRI, and Dr. Kumar will explain why. For migraines, treatment typically involves two components: a daily preventive medicine to reduce the frequency of attacks, and a fast-acting rescue medicine for when an attack breaks through. For patients with chronic migraine (15 or more headache days per month), Dr. Kumar offers CGRP-inhibitor therapy — a newer class of medicine that targets the specific chemical driving migraines — and Botox injections for eligible patients. For tension-type headaches, treatment often focuses on muscle relaxants, posture correction, and stress management alongside medication. For cluster headaches, the approach is different again: oxygen therapy during attacks and specific preventive medicines timed to the cluster period. Beyond medication, Dr. Kumar walks every patient through trigger identification — sleep regularity, dietary triggers, screen habits, hydration, stress patterns, and posture — because medication alone is rarely the complete answer. Most patients begin to notice meaningful improvement within 4–8 weeks of starting the right preventive treatment. Some patients need 2–3 medication adjustments before finding the best fit — this is normal, not a failure.

• A sudden spinning sensation when you turn over in bed or look up
• The room seems to rotate even when you're standing still
• Brief episodes of unsteadiness, lasting seconds to minutes
• Nausea or vomiting that comes with the dizziness
• A feeling of being pulled to one side when you walk
• Hearing loss, ringing in one ear, or a 'full' sensation with the spinning

True vertigo is a real spinning — as if you, or the world around you, is rotating. People describe gripping the bedrail when they turn in their sleep, holding the wall in the bathroom, feeling like the ceiling is sliding. It can come in seconds-long bursts (BPPV) or last for hours (vestibular neuritis, Meniere's disease). 'Lightheadedness' usually has a different cause — blood pressure, anxiety, heart rhythm — and the first job is to figure out which one is yours.

Most vertigo comes from the inner ear, where tiny crystals called otoconia help us stay oriented in space. When these crystals slip out of place, you get BPPV — the most common cause of vertigo, especially in middle-aged and older adults. Other causes involve inflammation of the balance nerve (vestibular neuritis), fluid buildup in the inner ear (Meniere's disease), or — much more rarely — problems in the brainstem. The good news: most causes are highly treatable, and many of them without medication at all.

Dr. Kumar starts with a focused examination — including the Dix-Hallpike test for BPPV, which can diagnose the most common cause of vertigo in about 90 seconds. For BPPV, treatment is often immediate: a gentle repositioning manoeuvre (the Epley) that moves the crystals back where they belong. Many patients walk out of the clinic with their vertigo resolved that same visit. For other causes, treatment is matched to the underlying problem — vestibular rehabilitation exercises, anti-vertigo medication for acute attacks, dietary changes and longer-term plans for Meniere's, and (rarely) imaging if a central cause is suspected. For a deeper guide to vertigo — including vestibular rehabilitation and Ménière's management — see our full Vertigo & Dizziness page →