Parkinson's Disease

Parkinson’s disease is a brain disorder that is diagnosed in an estimated 60,000 Americans each year. It occurs when nerve cells, or neurons, in certain parts of the brain die or become impaired and can no longer produce dopamine, the chemical that enables the body to coordinate muscles and movement. Symptoms begin to appear when approximately 80 percent of the cells that produce dopamine are damaged.

More than 1 million people with the disease typically show signs of tremors in the hands, arms, legs, jaw and face, as well slowness of movement, stiffness and problems with balance. Both men and women can be affected by Parkinson’s disease, which also crosses all social, ethnic, economic and geographic boundaries.

Although a small number of patients may be diagnosed under the age of 50, most cases of Parkinson’s disease are identified in people over 65. Blood tests and X-rays cannot be used to diagnose the disease. Rather, blood tests and brain scans, such as magnetic resonance imaging, may be done to rule out other conditions with similar symptoms. The diagnosis may then be confirmed after a thorough examination. There is no cure for Parkinson’s disease, but symptoms can be managed through medications, surgery or a combination of both.

One of the more commonly prescribed medications for Parkinson’s disease is levodopa. This medicine can reduce symptoms of slowness, stiffness and tremor. Levodopa works in the brain where it is converted into dopamine. It is always taken in conjunction with an enzyme inhibitor called carbidopa because blood enzymes would break down most of the levodopa before it could reach the brain.

Substitutes for levodopa, called dopamine agonists, have been developed that do not have to be taken with an enzyme inhibitor. However, these medications tend to cause other side effects.  Medications that do not stimulate dopamine production also can be taken to manage symptoms of Parkinson’s disease. Medications should be managed under close physician supervision because each person reacts differently to different drugs.

Deep brain stimulation offers a surgical alternative to medications to treat symptoms of Parkinson’s disease. This procedure involves surgically implanting a battery-operated medical device called a neurostimulator. Similar to a heart pacemaker, it delivers electrical stimulation to specific areas of the brain that control movement and blocks abnormal nerve signals that cause symptoms. The neurostimulator is about the size of stopwatch and usually is implanted under the skin near the collarbone. It is attached by an extension wire passed under the skin of the shoulder, neck and head to an electrode, or lead, which is implanted into the brain through a small opening in the skull. 

The deep brain stimulation system provides continuous symptom control and can be adjusted as needed. It does not damage healthy brain tissue and can be reversed if necessary. Medications may still be required, but at reduced levels for most patients.

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When To See a Neurologist for Headaches?

A headache that’s recurring or too severe may make you wonder whether you should see a neurologist. A neurologist's visit may not be necessary if your headache goes away on its own or with rest or self-care. But if it’s so debilitating that it disrupts your daily activities, it may be caused by other underlying conditions that require a thorough evaluation from a doctor.

Migraines and severe headaches affect one in every six adults in the U.S.A. Headaches usually occur on both sides of the head as well as the forehead, temples and nape. The ache can range from mild to severe and can be triggered by stress, anxiety, eyestrain and muscle strain. On the other hand, migraine is characterized by symptoms aside from headache, such as nausea, vomiting, neck and shoulder pain and many more.


When to See a Neurologist for a Headache?

If your headache becomes too severe and frequent to bear, it may be time to see a primary care doctor. You may be referred to a neurologist if your headache doesn’t improve with initial treatment. A neurologist specializes in diagnosing and treating conditions that affect the brain, spinal cord, peripheral nerves and muscles.

Seek medical help immediately for any of the following:

  • This is the first time you have had a headache this painful, and it disrupts your daily activities.
  • Your headache suddenly comes on an explosive or violent pain. This is an emergency condition that may be caused by a ruptured blood vessel in the brain. Call 911 right away or go to an emergency room near you.
  • Your headache worsens over 24 hours.
  • Your headache happens with a head injury.
  • You have a severe headache behind an eye with redness in that eye.
  • You have a history of immune system disorder or cancer and start to develop a new headache.
  • You experience any of the following along with your headache:
    • Balance loss
    • Confusion
    • Fever
    • Memory loss
    • Nausea
    • Problems moving your limbs
    • Slurred speech
    • Stiff neck
    • Vision changes
    • Vomiting

If possible, take note of the following details so you may mention them to your doctor during your appointment:

  • When your headaches occur
  • Whether noise or light bothers you during headaches
  • How much you slept before your headaches
  • Whether you experience vision changes before or during headaches
  • Food or drink you consumed in the last 24 hours before your headache
  • Any activities you’ve been doing before your headache started
  • Any weather changes at the time of your headaches
  • Any previous headache diagnosis or treatments you’ve tried


What To Expect at Your Doctor’s Visit?

Your doctor will inquire about your personal and family medical history and examine your head, ears, throat, eyes and neck. You will be asked questions related to your headaches. Your doctor may order medical tests such as blood tests, imaging tests or sinus X-rays if they need more information about your condition.

Your doctor may recommend over-the-counter pain relievers and other medications to relieve your headache. If they don’t work, you may be given prescription medications. Make sure to strictly follow your doctor’s instructions about properly taking these medicines, as overusing them may result in a medication-overuse headache.

Lifestyle and diet changes may be recommended as treatments, such as exercising regularly, eliminating foods that trigger headaches, using relaxation techniques and managing stress. If there is little to no improvement to your headache despite these treatments, you may be referred to a neurologist who will perform neurological examinations to rule out or identify other conditions that may be causing your headache.

Don’t wait too long to call for a doctor’s appointment for your debilitating headache or if you experience other symptoms along with it. See a doctor as soon as you can.


American Headache Society
National Institute of Neurological Disorders and Stroke
National Library of Medicine
U.S. Department of Veterans Affairs