Plan migraine prevention online

Common symptoms

• Four to fourteen headache days a month despite an attack medicine that works
• Wanting to reduce attacks before they start
• Needing a plan for migraine attacks and nausea
• Wanting to restart a preventive medicine that helped before

May fit online care

• Adults 18 to 64
• You are 18 to 64 with a prior migraine diagnosis from a clinician
• Your attacks match your usual pattern
• You have 4 to 14 headache days a month
• With fewer than 4 headache days, attacks seriously disrupt work or daily life and need case-by-case review
• You can describe your headache history and use of attack medicines

Look for another care setting

• A sudden 'thunderclap' headache or the worst headache of your life, headache with fever and stiff neck, a new rash or confusion, new weakness, numbness, trouble speaking, vision loss, double vision or clumsiness, a first-ever severe headache, or a severe or worsening headache after a head or neck injury, with loss of consciousness, repeated vomiting, or while taking a blood thinner (call 911).
• A seizure for the first time (call 911).
• Eye pain, or sudden blurred or decreased vision, soon after starting topiramate (a red eye or nausea may also be present; possible acute angle-closure glaucoma: call 911 or go the nearest emergency department; this is different from ordinary light sensitivity).
• Any headache, even mild, after a head or neck injury still needs a same-day in-person evaluation (the examining clinician decides whether imaging is needed), even without the severe features above.
• A new or different headache pattern starting at age 50 or older, or headaches steadily getting worse over weeks.
• Headache brought on by coughing, straining, exertion or sex, or that changes with position.
• Pregnancy, planning pregnancy in the next year, or breastfeeding.
• Age 65 or older.
• Heart disease, a stroke or mini-stroke, poor circulation in the legs or arteries (peripheral vascular disease), ischemic bowel disease, a very slow pulse or heart block, Wolff-Parkinson-White syndrome or another accessory heart pathway, or uncontrolled blood pressure (these also rule out a triptan for attacks).
• Hemiplegic or brainstem-aura migraine.
• Fifteen or more headache days a month, or a triptan, ergot, opioid, combination pain reliever or mix of acute headache medicines on 10 or more days a month, or plain pain relievers alone on 15 or more days a month.
• Cancer now or in the past, HIV, an organ transplant, or a medicine that weakens the immune system.
• Known swelling of the optic nerve (papilledema).
• A delivery in the last 12 weeks (a new or severe headache after giving birth needs prompt in-person care; call 911 for a severe headache that will not go away, vision changes, chest pain, trouble breathing or a seizure).
• Thoughts of harming yourself.