Questions to Ask Your Doctor About Migraines
For adults whose migraines have turned frequent or chronic and who have an appointment coming up with a family doctor, a neurologist or a headache specialist. The list follows the visit: the diagnosis and why the attacks have multiplied, triggers and the headache diary, what to take in an attack and how often is too often, prevention from the older tablets to Botox and the CGRP drugs, work and daily life, and last the emergency signs and the follow-up. Pick the handful that fit this visit, and read the notes as help with asking, not as medical advice.
The questions
Each question, and why to ask it
Diagnosis
Are these headaches migraine, and what in my description tells you that?
Why ask it
Migraine is usually diagnosed from the story of the attacks, not from a test, so the answer should point back to things you said: how long they last, the nausea, the need for a dark room. If the doctor names a second headache type alongside it, get both names written down.
Is my migraine episodic or chronic, and how many headache days a month is the dividing line?
Why ask it
Doctors generally count every day with a headache, the mild ones included, so bring a real tally and not an impression. The label can decide which treatments you are offered or covered for, and those rules vary, so ask how it works where you are treated.
Why have my migraines become more frequent over the past year or two?
Why ask it
Suspects the doctor may walk through include how often you take pain relief, sleep, weight, caffeine, mood and hormonal changes. Push for the one or two they think apply to you, since those are the ones worth working on first.
Can chronic migraine go back to episodic, and what would give me the best chance of that?
Why ask it
The chronic label is not always permanent, so this is a fair thing to ask and not wishful thinking. Have the doctor name the two or three things that would matter most in your case, and settle on the number of headache days a month you are aiming for first.
What else could be causing headaches this often, and how have you ruled it out?
Why ask it
You are listening for named alternatives and a reason each one does not fit, even if the reason is simply the exam and a pattern that has held for years. Say the fear you came in with out loud here, because a worry nobody mentions does not get answered.
Do I need a brain scan or blood tests, or is my history enough?
Why ask it
Plenty of people with a long, stable migraine pattern are told no scan is needed, and the reasoning is worth hearing so you stop wondering. Ask which change in your headaches would make the doctor order one after all.
Before the pain I see zigzag lights, and sometimes one hand goes numb or I lose my words. Is that an aura?
Why ask it
Describe it by the clock: how it starts, how fast it spreads, how long until it clears, and whether the headache always follows. Whether you have aura can bear on other choices, some kinds of hormonal contraception among them, so ask what it changes for you.
Could my neck, jaw, sinuses or eyesight be driving these, or are they part of the migraine?
Why ask it
A tight neck or pressure in the face can be part of a migraine attack, which is how attacks come to be blamed on posture, sinuses or an old pair of glasses. If the doctor thinks one of these is a separate problem, ask who should look at it and whether it alters the migraine plan.
Are frequent migraines doing lasting harm to my brain, or raising my risk of a stroke?
Why ask it
People tend to carry this one in silently, usually after reading something online late at night. Get the answer as it applies to your type of migraine, and find out whether smoking, blood pressure or a contraceptive pill changes it for you.
Would a neurologist or a headache clinic do anything for me that you cannot?
Why ask it
A family doctor can manage a great deal of migraine, so this is not a slight. What you want is the trigger for a referral: a number of failed treatments, a treatment only a specialist can prescribe there, or a doubt about the diagnosis. Find out the wait as well.
Triggers and diary
What do you want me to write in a headache diary, and for how many weeks?
Why ask it
Ask for the shortest version the doctor will really read: usually which days had any headache, how bad, and what you took. A diary that takes thirty seconds a day gets kept, and one with twelve columns is abandoned in a week.
Which of the triggers I suspect look real to you, and which are probably coincidence?
Why ask it
Bring your list and let the doctor cross things off. Some doctors point out that a craving or a stiff neck in the hours before can be the attack starting, not its cause, which may take a few foods off your banned list.
Do my attacks track my menstrual cycle, and would that change how we treat them?
Why ask it
Mark period days in the diary for two or three cycles before this conversation if you can, since the pattern is hard to see from memory. If the link is there, ask whether a short course of treatment timed around those days is an option for you.
My attacks often land on the first day off after a hard week. Is that a pattern you recognize, and what can I do about it?
Why ask it
Look for it in the diary before the visit: weekends, the first morning of a vacation, the day after a deadline. If the doctor agrees it is real, go through the later wake-up, the later first coffee and the drop in stress one at a time, since each has a different fix.
Is a steadier routine for sleep and meals likely to help me, and where would you start?
Why ask it
Be honest about night shifts, small children, sleeping late on weekends and the lunches you skip, because advice that ignores them will not last. One change with a date to review it is worth more than a handout of ten.
How much caffeine is reasonable for me, and will cutting back make things worse at first?
Why ask it
Count everything: coffee, tea, energy drinks, cola and any painkiller that contains caffeine. If the doctor suggests reducing, ask how gradually to do it and how long a rough patch to expect, so a bad first week does not send you straight back.
Is it worth cutting out a food or alcohol to test it, and how would I do that properly?
Why ask it
Expect a cautious answer, since broad elimination diets are hard to keep up and easy to misread. If one item is worth testing, ask how long to drop it and what in the diary would count as a result.
Acute medicine
What should I take when an attack starts, and how early in the attack?
Why ask it
Many people wait to see whether it turns into 'a real one' and take the medicine too late to do much. Get the instruction as a sentence you could follow half-blind at 3 a.m.: which tablet, what dose, at which sign.
If the first dose has not worked after a couple of hours, what do I do next?
Why ask it
The answer should say whether you can repeat the dose, add a second kind of medicine, or neither, and the most you can take in a day. Write it on the box or in your phone, since nobody reads a package insert well in the middle of an attack.
Which kind of acute medicine suits my attacks: an anti-inflammatory, a triptan or one of the newer tablets?
Why ask it
Say what you have tried, at what dose, and what happened, because 'triptans do not work for me' sometimes means one triptan taken late. Ask how many attacks to test a new one on before calling it a failure.
What are my options when nausea or vomiting means I cannot keep a tablet down?
Why ask it
Possibilities a doctor may raise include an anti-nausea medicine, a tablet that melts on the tongue, a nasal spray or an injection you give yourself. Mention how quickly your attacks peak, since that often decides which form makes sense.
How will we know an acute medicine is doing its job?
Why ask it
Agree on a plain test, such as being able to function again within a couple of hours without the headache returning the next day. If yours falls short of that most of the time, say so instead of settling for 'it takes the edge off'.
How many days a month can I take each of my painkillers and triptans before the medicine itself starts causing headaches?
Why ask it
The limit is usually given as days per month, not tablets, and it can differ between a plain painkiller, a triptan and a combination product. Get the figure for each thing you take, and ask whether the newer acute tablets are counted the same way.
Could I already have medication-overuse headache?
Why ask it
The figure to have ready is how many days last month you took any pain relief, over-the-counter tablets included. Nobody is accusing you of anything: frequent use is what frequent pain produces, and the doctor needs the true number to plan around.
If I need to cut back on pain relief, how do we do it, and what will the first weeks be like?
Why ask it
Ask whether to stop at once or step down, what you may use on the worst days, and whether a preventive starts at the same time. Headaches often get worse before they improve, so pick a stretch with no deadline or vacation in it and tell someone at home what you are doing.
Is there any migraine medicine I should avoid because of my heart, blood pressure or other prescriptions?
Why ask it
Triptans, for example, are often not advised for people with certain heart and circulation conditions, and some combinations of medicines need checking. Mention any family history of early heart disease or stroke, and any antidepressant you take.
Prevention
Have I reached the point where a preventive medicine makes sense?
Why ask it
Doctors weigh how many days you lose, how well acute treatment works and how often you are reaching for it. If the answer is 'not yet', ask what number in your diary would change it.
Which preventives would you consider for me, and why in that order?
Why ask it
The older options were borrowed from blood pressure, epilepsy and depression treatment, which surprises people when they read the label. The order is often shaped by your other conditions and by what an insurer or health service requires first, so ask which of those is driving it.
Could a preventive also help my sleep, mood or blood pressure, or make one of them worse?
Why ask it
This is often how a doctor chooses between otherwise similar options, so volunteer the details: trouble sleeping, low mood, weight you are worried about, low blood pressure, asthma. A side effect you would not put up with is worth naming before the prescription is written.
How long do I give a preventive, and at what dose, before we judge it?
Why ask it
Preventives are generally judged over a couple of months at a proper dose, and many are started low and raised slowly. Get the date written down, since people often quit in week three, right when side effects have shown up and benefit has not.
What would a good result on this preventive look like in my diary?
Why ask it
Zero migraines is rarely the target. A common yardstick is roughly half as many headache days, or attacks that respond better to acute medicine, and agreeing on it now saves an argument with yourself later about whether it is working.
Which side effects should I expect from this one, and which would make you stop it?
Why ask it
Have them sorted into three piles: likely to fade, worth a message to the office, and stop and call today. Ask specifically about thinking, weight, mood and tingling if those would matter to your work or your life.
I have tried preventives before and given up. Did each one get a fair trial?
Why ask it
Bring names, the highest dose reached, how many weeks you took it and why you stopped. A medicine dropped after ten days at a starter dose may be worth another look, and a properly failed one often counts toward eligibility for newer treatments.
Would Botox be an option for me, and what does a course involve?
Why ask it
It is generally offered for chronic rather than episodic migraine, as a set of small injections around the head and neck repeated every few months. Ask who gives it locally, how many rounds they try before judging it, and what you need to have tried first.
Am I a candidate for one of the CGRP medicines, and which form would you choose?
Why ask it
This group includes injections you give yourself monthly or less often, an infusion, and tablets, so say which you could live with. Have the doctor tell you what is known about longer-term use and whether any of your other conditions gives them pause.
Will my insurer or health service pay for Botox or a CGRP drug, and what does the approval need from you?
Why ask it
The rules belong to your country, plan or hospital, and they often ask for a diary and a list of treatments that failed. Find out who files the request, how long it takes, and what happens if it is refused.
Is a supplement such as magnesium, riboflavin or coenzyme Q10 worth trying, and at what dose?
Why ask it
Doctors differ on how much these do, so you are asking for this doctor's view and a dose, not a shrug. Check that it is safe with your kidneys, your pregnancy plans and your other medicines, and judge it with the diary over a set number of weeks like any other preventive.
Would a nerve-stimulation device, biofeedback or cognitive behavioral therapy add anything for me?
Why ask it
These tend to be add-ons, and they suit people who cannot take, or do not want, more medicine. Availability and cost vary a great deal, so ask what can be had locally and whether a device can be rented or returned before you commit to buying one.
If the preventive works, how long do I stay on it, and how would we come off?
Why ask it
Some doctors review after six months to a year of good control and try a slow reduction. Hear what the plan would be if the headaches crept back, so stopping feels like an experiment and not a cliff.
Work and daily life
Which changes at work tend to help people with migraine, and will you put them in writing for my employer?
Why ask it
Examples to discuss are lighting, screen breaks, a quiet place to wait out the first hour, flexible start times and working from home on recovery days. What an employer has to agree to depends on where you live and your contract, so ask who advises on that locally.
I am missing a lot of work. What are my options for sick leave or disability support, and who helps with the forms?
Why ask it
The doctor can document days lost and what you cannot do during and after an attack, which is where the diary earns its keep. The programs themselves differ by country, state and employer, so ask to be pointed to whoever knows the local ones.
Is it safe for me to drive during an aura, in an attack or after taking my acute medicine?
Why ask it
Visual aura and some medicines can each make driving a bad idea for a few hours, and the rules on fitness to drive are set locally. Work out a fallback now for the school drop-off or the commute, before you are deciding at the roadside.
Exercise sometimes sets off an attack. How do I stay active without paying for it?
Why ask it
Describe what you did, how hard, and how soon the headache came. Doctors usually want you moving, so expect practical adjustments such as a longer warm-up, fluids, food beforehand or a different intensity, and try one change at a time.
What should I plan for when I travel, with flights, time zones and carrying my medicine?
Why ask it
Cover the practical points: enough acute medicine in your carry-on bag, a letter for injectables, how to shift the timing of a daily preventive, and what to do if you run out abroad. Rules on bringing medicines into a country vary, so check the destination's before you fly.
I have started dreading the next attack and my mood is low. Is that part of migraine, and who can help with it?
Why ask it
Planning your life around a possible attack wears people down, and it is easy to leave out of a visit that is meant to be about pain. Say what you have stopped doing, and ask whether mood or anxiety would be treated by this doctor or by someone else.
Which of my migraine medicines are a problem in pregnancy or while breastfeeding, and what would I use instead?
Why ask it
Raise this well before trying to conceive, because some preventives are ones doctors want stopped ahead of time and the swap takes planning. Ask the same about contraception: which methods sit well with your type of migraine and your medicines.
Are my migraines likely to ease as I get older or after menopause, or should I plan for the long run?
Why ask it
No doctor can promise a date, but the pattern they have seen in patients like you is worth hearing. If you are in perimenopause, describe how your cycle has changed, and ask how hormone treatment would sit with your migraines before anyone prescribes it.
Does migraine run in families, and should my children's headaches be looked at?
Why ask it
Say who else in the family gets them and what theirs are like, since a doctor may count that toward your own diagnosis. If a child is already complaining of headaches, find out what is worth watching and who would see them.
Emergencies and follow-up
What would make a headache an emergency for me and not just another bad migraine?
Why ask it
Have the doctor list the signs in plain words for you. The ones commonly named are a sudden headache that is the worst of your life, fever with a stiff neck, weakness, confusion, a seizure, or a headache after a blow to the head. Put the list where the people you live with can find it.
How do I tell an aura from a stroke?
Why ask it
Doctors often describe aura as creeping in over minutes and stroke as arriving all at once, but get the rule that fits your own aura. Ask what to do when you cannot tell, which is usually to treat it as an emergency, and whether a first-ever aura or one that outlasts your usual should be handled that way.
What is the plan when an attack runs past three days or nothing I take touches it?
Why ask it
A long attack has its own treatments, and many clinics would rather hear from you than have you sit it out. Get the threshold in hours or days and the place to go: the office, an infusion clinic, urgent care or the emergency room. Ask too whether a rescue medicine kept at home could cover those attacks.
If I do end up in the emergency room, what should I tell them, and is there any treatment you would want me to steer away from?
Why ask it
Carry a note on your phone: your diagnosis, what you took and when, what has worked there before, and your doctor's name. Emergency departments vary in what they give for migraine, so hear your doctor's preference before the night you need it.
Who do I contact between appointments when the plan stops working, and how soon will someone answer?
Why ask it
Find out whether that is a nurse line, a patient portal or the front desk, and what counts as urgent enough for a reply the same week. Waiting four months for the next slot while taking pain relief daily is one way overuse gets started.
What should I bring to the next visit so we can tell whether the plan is working?
Why ask it
Usually a month-by-month count of headache days and of days you took acute medicine, plus any side effects with dates. Book the follow-up before you leave, since the review date is what turns a prescription into a trial with an end.
Getting more from a migraine appointment
Practical guidance for the conversation itself
A headache diary the doctor will read
Count days before anything else
A lot of treatment decisions turn on how many days in the month had any headache at all, so mark every day as clear, mild or bad. A wall calendar and three colored pens do this as well as an app.
Log what you took
Next to each headache day, note every dose of acute medicine, including the plain painkillers bought off the shelf. The number of medicine days per month is the second figure a doctor looks for, and it is the one people most often underestimate.
Keep triggers to a line
Add a period, a short night, a missed meal or alcohol in a word or two, and leave the rest out. Long daily essays about food and weather are rarely read, and they make the pattern harder to see.
Total it before the visit
The night before the appointment, add up each month: headache days, severe days, medicine days, and days of work or plans lost. Put those four numbers at the top of the page and hand that over first.
What to bring and what to say
Write out your treatment history
List every migraine medicine you have tried, acute and preventive, with the dose, how long you took it and why it stopped. That single page saves more time than anything else you can bring, and it is often what an approval for a newer treatment depends on.
Open with the problem you most want fixed
'Too many headaches' is hard to act on. 'I am taking a triptan three days a week and still missing work' tells the doctor where to start, so settle on your sentence before you walk in.
Describe a bad day by what stops
A pain score out of ten says little on its own. The shifts you left early, the school pickups someone else covered and the evenings spent in a dark room are what show how much treatment is justified.
If an attack lands on appointment day
When you book, ask whether the visit can switch to phone or video if you are too unwell to travel, and what the cancellation rule is. If you do go in mid-attack, hand over the written pages and let them speak for you.
Leaving with a written migraine plan
Three layers on one page
A workable plan says what you take every day or every month to prevent attacks, what you take when one starts, and what you do when that fails. Ask the doctor to fill in all three, even if one of them is 'nothing for now'.
A ceiling on acute days
Have the maximum number of days per month written beside each acute medicine. It is far easier to notice you are close to the limit when the limit is on the page.
A review date
Every new treatment should come with the date it will be judged and the measure it will be judged by. Without one, a medicine that is doing nothing can drift on for a year.
A way back in
Note the phone number or portal for the weeks when the plan falls apart, and the signs that mean emergency care instead. Keep one copy on your phone and another where the household can find it.
When nothing seems to work
Go back over the old trials
Before concluding that you have tried everything, check each past preventive against two questions: did it reach a full dose, and did you stay on it long enough? Some 'failures' turn out to have been side effects in the first two weeks.
Look hard at the medicine count
If you are treating pain on most days, ask plainly whether that could be keeping the headaches going. It is an uncomfortable question, and other treatments may work poorly until it has been dealt with.
Ask what a specialist could offer
A headache clinic may have treatments, nerve blocks or infusions that a general practice does not, though waits and referral rules differ from place to place. Ask your doctor to say honestly whether you have reached that point.
Keep the diary going anyway
A flat stretch feels like the moment to stop recording, but the record is your evidence for the next treatment and often for its funding. Even a bare tally of days is enough.