Overview
Migraine involves activation of the trigeminovascular system, producing throbbing head pain with sensitivity to light and sound, nausea and disability. Around a third of people experience aura - visual or sensory symptoms preceding the pain.
Common triggers include disrupted sleep, missed meals, dehydration, stress (or relief from stress), hormonal changes and alcohol. Frequent use of painkillers can itself cause medication-overuse headache.
When to seek urgent medical help
- • Sudden severe headache reaching maximum intensity within seconds - emergency
- • Headache with fever, neck stiffness, rash, confusion or weakness
- • New headache pattern after age 50, or aura lasting over an hour
Symptoms and signs
- Moderate to severe one-sided throbbing head pain
- Nausea or vomiting during attacks
- Sensitivity to light, sound or smell
- Visual aura such as zigzag lines or blind spots before the headache
- Pain worsened by routine physical activity
- Attacks lasting from 4 to 72 hours with normal periods in between
Management and treatment
Acute treatment works best taken early in the attack: a triptan combined with an anti-inflammatory and an anti-sickness medicine. Preventive treatment is considered when you have four or more migraine days a month.
Your ChatDoc doctor confirms the diagnosis against international criteria, screens for cardiovascular contraindications to triptans, checks for medication-overuse headache and prescribes an acute and preventive plan.
Prescription treatment options
Triptans (sumatriptan, rizatriptan)
Migraine-specific acute treatment taken at the onset of pain.
NSAIDs and anti-emetics
Naproxen or aspirin with metoclopramide or prochlorperazine to improve absorption and control nausea.
Preventive medication
Propranolol, amitriptyline, candesartan or topiramate for frequent attacks.
Trigger and lifestyle plan
Headache diary, sleep regulation, hydration, magnesium and riboflavin where appropriate.
Any prescription is issued only after a doctor has reviewed your case and considers the treatment safe and appropriate for you.
Your online Migraine & Headache assessment
- 1
Tell us about your concern
Share symptoms, past treatments, medicines and relevant health information.
- 2
Upload clear photos
Upload photos of your concern where applicable.
- 3
Doctor reviews your case
Technology helps organise your answers, but every assessment and prescription decision is made by a doctor, who may message you if they need more information.
- 4
Get your personalised plan
A personalised prescription is issued if treatment is clinically appropriate.
Prognosis and outlook
Around 70% of people respond well to a triptan, and switching agents helps many of those who do not. Preventive treatment typically halves attack frequency over 8-12 weeks.
Migraine often improves with age and after menopause, and identifying triggers gives many people long stretches without attacks.
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This page is general medical information and does not replace a personal consultation. Always seek urgent care for severe or rapidly worsening symptoms. ChatDoc is not an emergency service. Call 999 (UK) or 112 (EU) for life-threatening emergencies or 111 for urgent non-emergency help. Do not wait for an online reply.