Migraine

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• The worst headache of your life, reaching full intensity within seconds to a minuteCall 911 or go to an emergency department — a headache that arrives that abruptly needs ruling out urgently.
• Headache with fever and a stiff neckGo to an emergency department.
• Headache with new weakness, numbness, or difficulty speakingCall 911. Some migraines cause aura, but new symptoms like these need urgent assessment rather than assumption.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• A headache that is clearly different from your usual patternYou know your own migraines better than anyone. A change in the pattern is worth an appointment even when each individual feature seems unremarkable.
• A first severe headache after the age of 50
• Headache that is worse lying flat, or on coughing, straining or bending

What usually happens

Attack treatment and prevention are two different things. Something taken to stop an attack is not the same as something taken daily to have fewer of them — and people are often on only the first when they need both.

Treating attacks too often causes its own headache. Using attack medication on more days than not produces medication-overuse headache, which feels like the migraine getting worse and tempts you to take more. Breaking that cycle is treatment in itself.

Prevention is worth considering once attacks are frequent or disabling enough to cost you days. It does not eliminate migraine; it aims to make attacks fewer and less severe.

A diary is genuinely useful here, more than in most conditions — frequency, triggers and what you actually took are hard to recall accurately and they steer the whole plan.

At your appointment

We will ask how many days a month you have headache, how many you are unable to function, and — importantly — how many days you take something for it.

We will go through what you have tried, at what dose and how early in the attack. Taking attack treatment early makes a large difference and is a common miss.

Scans are usually not needed when the pattern is typical and the examination is normal; that is a considered decision, not a shortcut.

If attacks are frequent we will discuss prevention, what to expect from it, and how long to give it before judging.

Worth asking

• —How many days a month am I taking something — and is that too many?
• —Should I be on something preventive as well as something for attacks?
• —How early in an attack should I take it?
• —How long before I can tell whether a preventive is working?