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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Migraine is diagnosed from your attack history by video, so typical cases need no brain scan; acute treatment with NSAIDs and triptans and daily preventives are prescribed after cardiovascular screening.
- What it is: a brain disorder of attacks: one-sided throbbing headache lasting 4 to 72 hours with nausea, vomiting or sensitivity to light and sound, with aura in about 1 in 4 people; it affects about 1 in 7 people, women 3 times as often as men.
- Triggers: stress and the let-down after it, missed meals, dehydration, too little or too much sleep, alcohol, the fall in oestrogen before a period, and weather or screen glare; a diary over 2 to 3 months reveals your own.
- Acute treatment: triptans work best taken early in the headache phase, not once the attack is established; using triptans or combination painkillers on 10 or more days a month can itself cause medication-overuse headache.
- Prevention: a daily preventive is considered when migraine costs 4 or more days a month, judged over 2 to 3 months, with the aim of halving attacks; lifestyle regularity cuts attacks on its own.
- Emergency: call 112 for a thunderclap headache, or a headache with fever and a stiff neck or rash, one-sided weakness, slurred speech, a drooping face or confusion; a first aura after 50 needs prompt in-person assessment.
Call 112, do not book online, for a thunderclap headache (sudden, worst-ever pain peaking within about a minute), for headache with fever, a stiff neck or a new rash, or for headache with one-sided weakness, slurred speech, a drooping face or confusion: treat these as a stroke or serious infection until proven otherwise. See a doctor in person promptly if your first migraine-like attack arrives after age 50, an aura lasts longer than an hour, or your headache pattern suddenly changes.
Can an online doctor treat migraine?
Yes, in most cases. Migraine is diagnosed from the attack history rather than a scan or blood test, so a video consultation can often provide enough information to assess it.[2] The doctor can confirm the pattern, prescribe acute treatment such as NSAIDs or triptans when they are safe for you, and start preventive medication when attacks are frequent. Red-flag features, listed above, need in-person assessment rather than a video call.
Listen: Migraines Treatment Online
The audio version of this topic from the Mobi Doctor podcast. Open the episode.
How an online consultation helps with migraine
- Diagnosis from your story: Migraine is diagnosed from the pattern (attack length, one-sided throbbing, nausea, light sensitivity), which a video consultation captures as well as a clinic visit for typical cases.
- Acute treatment that fits your health: Anti-inflammatories, anti-sickness medicines and triptans when they are safe for you, after screening your cardiovascular history, because triptans are not suitable for everyone.
- Prevention when attacks pile up: If migraine claims several days a month, the doctor can discuss daily preventive options and review how they perform.
- Overuse protection: Renewals come with a check on how many days a month you treat, because too-frequent painkillers or triptans can convert migraine into daily headache.
What the doctor checks in an online migraine consultation
A migraine consultation is a structured assessment, not a repeat-prescription form. The doctor will typically check:
- The attack pattern against diagnostic criteria: frequency, duration (typically 4 hours to 3 days), one-sided throbbing pain, worsening on movement, nausea, light and sound sensitivity, and any aura.[2]
- Red flags first: thunderclap onset, fever with a stiff neck, new neurological symptoms, a first attack after 50 or a clearly changing pattern, which route you to in-person or emergency care instead.
- Cardiovascular screening before triptans: a previous heart attack, stroke or TIA, uncontrolled blood pressure or significant vascular disease, because triptans narrow blood vessels and are not prescribed when these are present.[1]
- Your monthly medication-day count: ten or more days a month on triptans or combination painkillers, or fifteen or more on simple painkillers, can itself cause medication-overuse headache.[1]
- Disability and the prevention threshold: days lost to attacks, because several migraine days a month is the usual point at which daily preventive treatment earns a discussion.
- Hormonal factors: menstrual timing of attacks, contraception (combined hormonal contraception is not recommended with aura), pregnancy and pregnancy plans.
- Timing and technique of treatment: what you take, at which moment of the attack, and what happens when the first choice fails.
Come prepared with three months of history if you can: roughly how many attack days per month, how long attacks last, what you take and whether it works, and days missed from work or family life. Mention every regular medicine, including the contraceptive pill. A follow-up at six to eight weeks checks the plan against reality.
Reading the pattern of a migraine attack
The shape of an attack
A classic attack moves through phases. Many people get a warning day of yawning, food cravings, a stiff neck or mood change. Some then have an aura: visual zigzags, shimmering or blind spots spreading over five to sixty minutes, occasionally with tingling or difficulty finding words. The headache phase lasts four hours to three days: typically one-sided, throbbing, moderate to severe, worse on movement, with nausea and sensitivity to light and sound.[2] A washed-out “hangover” day often follows. Not every attack has every phase, and aura can occur without headache at all.
When should I worry about a headache?
Worry about a headache that is sudden and worst-ever, peaking within a minute; that comes with fever and a stiff neck; that follows a head injury; or that brings weakness, slurred speech or confusion. Call 112 for these. Also take seriously a first attack after 50, an aura lasting over an hour, or a clearly changing pattern.
These patterns point towards bleeding, infection or stroke rather than migraine. Migraine is vastly more common than all of them, but new features in a familiar condition are exactly what deserves a doctor’s attention, and saying so plainly is part of honest migraine care.
How is migraine different from tension or cluster headache?
Migraine typically causes one-sided, throbbing, moderate-to-severe pain lasting four hours to three days, worse on movement, with nausea and light sensitivity. Tension-type headache is milder, both-sided and pressing, like a band. Cluster headache causes short, excruciating attacks around one eye with restlessness, often at night, in runs lasting weeks.[2]
Swipe sideways to compare →
| Feature | Migraine | Tension-type | Cluster |
|---|---|---|---|
| Where it hurts | One side of the head (can switch sides) | Both sides, band-like | Strictly one side, around the eye |
| How it feels | Throbbing, moderate to severe | Pressing, mild to moderate | Stabbing, excruciating |
| How long it lasts | 4 hours to 3 days | 30 minutes to days | 15 minutes to 3 hours, often in nightly runs |
| Other signs | Nausea, light and sound sensitivity, aura in some | Usually none | Red watery eye, blocked nostril, restlessness |
| During an attack | You lie still in the dark | You carry on, uncomfortable | You pace, unable to stay still |
One more pattern matters: a headache present most days in someone using painkillers most days points to medication-overuse headache; see the warning under treatment options. Cluster headache has its own page under related conditions; tension-type headache is covered on the headaches page.
Which migraine treatment might the doctor recommend?
Treatment follows attack frequency and what you have already tried. This is the decision framework the doctors use, aligned with cited European and UK guidance:[1]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Occasional attacks that respond to early simple painkillers | Optimised early treatment: an adequate-dose NSAID or aspirin at onset, with an anti-sickness medicine if needed | Usually yes | No response to well-timed treatment, or the diagnosis is unclear |
| Attacks that shrug off simple painkillers | A triptan taken early in the headache phase, after cardiovascular screening | Usually yes | Cardiovascular contraindications, or repeated triptan failure despite format changes |
| Several migraine days a month despite good acute treatment | Daily preventive medication (for example propranolol, candesartan or amitriptyline), judged over 2–3 months | Usually yes, with reviews | Poor response after fair trials of more than one preventive |
| Headache on 15 or more days a month, or frequent treatment days | Medication-overuse assessment and a withdrawal plan alongside prevention | Often, case by case | Chronic migraine resisting treatment: neurology referral, including newer CGRP-targeted options |
| Thunderclap onset, neurological deficit, or fever with a stiff neck | Emergency assessment | No | Call 112 now; these are treated as stroke, bleeding or infection until proven otherwise |
Not sure which row is your migraine? A doctor can tell you in one consultation.
See available times →Triggers, diaries and hormones
Finding your triggers
Keep a simple diary for six to eight weeks: sleep, meals, stress, alcohol, exercise and attacks. Common patterns include missed meals, dehydration, short or irregular sleep, and stress let-down (the Saturday-morning migraine after a hard week). Triggers usually stack: a poor night plus a skipped lunch tips you over where either alone would not. A diary turns treatment from guesswork into targeting, and it is the first thing the doctor will ask about.
The menstrual link
Many women have attacks clustered from about two days before a period to the third day of bleeding, when oestrogen falls; these attacks are often longer and harder to treat. Note the timing in your diary, because it opens specific options, from planned anti-inflammatory use to hormonal strategies. One safety rule matters here: if you have migraine with aura, combined hormonal contraception (pill, patch or ring) is not recommended because of a raised stroke risk.[1] Tell any doctor who prescribes for you.
Special situations
Migraine in pregnancy and breastfeeding
Migraine often eases during pregnancy, especially in the second and third trimesters, but the treatment options narrow, so involve a doctor early rather than improvising. Paracetamol is the usual first choice; anti-inflammatories are restricted to specific stages of pregnancy and avoided in the third trimester; triptan use is a case-by-case discussion; and preventives such as topiramate and valproate are avoided.[4] Any new or unusually severe headache in pregnancy, particularly with visual disturbance or sudden swelling, needs urgent in-person assessment the same day.
Migraine at work: adjustments that help
Migraine is a leading cause of lost working days, and work can be made more migraine-tolerant.[3] Adjustments that genuinely help: screen breaks, glare-free lighting, regular meal breaks, predictable shifts and permission to treat early rather than soldiering on. If attacks are costing you multiple work days a month, that is precisely the threshold at which preventive treatment earns its place, so bring it up in the consultation.
Travel, flights and time zones
Travel stacks triggers: broken sleep, missed meals, dehydration and long screen hours in transit. Protect the basics deliberately (water, regular food, sleep as close to routine as the trip allows) and keep acute treatment in your hand luggage, not the hold. Medicines carry different brand names across the EU, so know your ingredient name (for example sumatriptan). And if an attack abroad brings any red-flag feature, the rules do not change with the scenery: 112 works in every EU country.
Treatment options for migraine
What you can do yourself
Treat early: medication taken at the first sign of the headache works far better than medication taken once the attack is established. Retreat to a dark, quiet room; a cold pack helps some people. Between attacks, regularity is protective: consistent sleep, meals, hydration, moderate caffeine and regular exercise. Over-the-counter ibuprofen or aspirin at an adequate dose, taken early, settles many attacks (ask a pharmacist what suits you), but keep count of how many days a month you treat.[5] Some people also try riboflavin (vitamin B2) or magnesium; the evidence is modest, so discuss rather than assume.
Prescription treatment
A prescription is never issued without a consultation, because acute migraine treatment carries real contraindications. For attacks that shrug off simple painkillers, triptans are the main acute option; they work best taken early in the headache phase, and a different triptan or format (melt-in-the-mouth, nasal spray) is worth trying if the first fails.[1] Honesty matters here: triptans narrow blood vessels, so they are not prescribed after a heart attack, stroke or TIA, with uncontrolled high blood pressure, or with significant vascular disease, and the doctor screens for this before prescribing. Prescription anti-sickness medicines ease nausea and help painkillers absorb. Opioids are not recommended for migraine and, like all controlled medicines, are not prescribed through online consultations.
If migraine costs you four or more days a month despite good acute treatment, preventive medication is worth discussing: options include propranolol, candesartan, amitriptyline and topiramate, each given a fair trial of two to three months. Topiramate needs reliable contraception because it can harm an unborn baby.[4] Headache on fifteen or more days a month (chronic migraine), or migraine resisting these steps, is grounds for specialist referral, including for newer CGRP-targeted treatments. And one warning above all: using triptans or combination painkillers on ten or more days a month, or simple painkillers on fifteen or more, can itself cause daily headache (medication-overuse headache), which is treated by withdrawal, not escalation.[1]
When migraine is treated online, and when you need in-person care
Treated online: typical migraine with a clear history; starting or adjusting acute treatment, including triptans after cardiovascular screening; starting and reviewing standard preventive medication; medication-overuse assessment and a supervised withdrawal plan; and menstrual-pattern planning, including contraception safety advice for migraine with aura.
In-person care: any red-flag presentation (thunderclap onset, neurological deficit, fever with a stiff neck, headache after significant head injury) goes to emergency care by 112, not to a video queue. A first migraine-like attack after 50, an aura lasting over an hour or affecting strength or speech, or a rapidly changing pattern needs in-person neurological assessment. Chronic migraine that resists standard preventives is referred to neurology, including for CGRP-targeted treatments. Suspected cluster headache has its own urgent pathway, and a new severe headache in pregnancy needs same-day in-person care.
When to get in-person care
Call 112 for: a thunderclap headache reaching maximum intensity within about a minute; headache with weakness down one side, slurred speech, a drooping face or confusion; headache with fever, a stiff neck or a spreading rash; a severe headache after a head injury; or a first seizure. Seek urgent in-person review the same day for a first migraine-like attack after 50, an aura lasting over an hour or affecting strength or speech, a rapidly escalating pattern, or a new severe headache in pregnancy, especially with visual disturbance or sudden swelling.
Treating a migraine at home: what helps and what does not
A dark, quiet room, hydration, and simple pain relief taken early rather than heroically late genuinely shorten attacks. A trigger diary, regular sleep and not skipping meals reduce how often they come. For mild, occasional migraine, that can be enough.
What home care cannot do: the medicines that actually abort a migraine attack, triptans, are prescription medicines in most of Europe, and so are the daily preventers that cut attack frequency for people losing days to migraine every month. If you are having regular attacks, home care is management, not treatment. A sudden worst-ever headache is different again: that is 112, not a dark room.
Staying at home is the point of Mobi Doctor: a licensed doctor over video, usually within 15 minutes, with no waiting room. If medication is the right answer, the prescription follows. Book a video consultation: the exact price is shown before you pay.
How long does a migraine last?
Untreated, a migraine attack lasts between 4 and 72 hours by definition, most commonly a day, with a washed-out hangover phase that can add another.
Getting rid of one fast: the honest answer is early treatment: simple pain relief at the very first sign works far better than heroic doses late, and prescription triptans, taken early, abort attacks for many people. Attacks that regularly cost you days deserve a prevention conversation, not just faster rescue. Book a video consultation: the exact price is shown before you pay.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about migraine: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Leave with your plan: everything agreed before you hang up: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
No sign-up needed
Not sure it’s migraine? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Headache can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about migraine
What is a migraine?
A migraine is a neurological condition that causes recurrent attacks: a moderate to severe, often one-sided, throbbing headache that worsens with movement and comes with nausea, vomiting or sensitivity to light and sound, lasting 4 hours to 3 days. About a quarter of people with migraine get an aura, usually visual, before the pain. Migraine affects about 1 in 7 people and runs in families.
What are the symptoms of a migraine attack?
A migraine attack often runs in stages: a warning phase a day before with yawning, cravings, mood change or neck stiffness; in some people an aura of flickering zigzags, blind spots, tingling or word-finding trouble lasting 5 to 60 minutes; then the headache with nausea and sensitivity to light, sound and smell; and a washed-out hangover phase for a day after. Not every attack has every stage.
What causes migraines?
Migraines come from an over-sensitive brain pain network that is partly inherited: a wave of nerve activity triggers the trigeminal system and inflames blood vessels around the brain. Attacks are set off by triggers that stack up, such as stress or its release, missed meals, dehydration, irregular sleep, alcohol, hormonal change before a period and sensory overload. Migraine is not caused by weakness, and it is not simply a bad headache.
How do I know it is a migraine and not a normal headache?
Migraine tends to be one-sided, throbbing and moderate to severe, worse when you move, and accompanied by nausea or sensitivity to light and sound; attacks last from 4 hours to 3 days and stop your day. Tension-type headache is milder, both-sided and pressing, without nausea, and lets you carry on. Cluster headache is shorter, excruciating and centred on one eye with a watering eye.
How long does a migraine last?
An untreated migraine attack lasts 4 to 72 hours, most commonly a day, with the washed-out after-phase adding another day for many people. Treated early with an anti-inflammatory or a triptan, most attacks ease within two hours. An attack that continues beyond 72 hours, or a headache that is different from your usual migraines, needs assessment rather than more of the same treatment.
How do I get rid of a migraine fast?
To stop a migraine fast, treat at the first sign: take an anti-inflammatory such as ibuprofen or aspirin or a triptan, or both together, with an anti-sickness tablet if you feel nauseous; then rest in a dark, quiet, cool room, hydrate, and sleep if you can. Waiting until the pain is severe makes treatment far less effective, and treating on more than 10 days a month risks medication-overuse headache.
Can an online doctor prescribe triptans in the EU?
Yes, but never without a consultation. The doctor first screens your cardiovascular history, because a previous heart attack, stroke, uncontrolled blood pressure or vascular disease rules triptans out, and can then send a prescription for a suitable triptan for your migraines to a pharmacy near you, with guidance on timing and on the monthly limit.
Do I need a brain scan for migraine?
Usually not. Typical migraine with a normal examination does not need imaging; scans are reserved for red flags such as thunderclap onset, new neurological signs, a first attack after 50 or a clearly changing pattern. If anything in your story needs a scan, the doctor says so directly and arranges it rather than treating blindly.
Can taking painkillers too often make migraine worse?
Yes. Using triptans, opioids or combination painkillers on 10 or more days a month, or simple painkillers such as ibuprofen or paracetamol on 15 or more, can cause medication-overuse headache: a near-daily headache that only settles when the overused medicine is stopped. Frequent migraines are the signal to add a preventive rather than more acute treatment.
When should I consider preventive medication for migraine?
As a rule of thumb: when migraine costs you four or more days a month, or attacks are fewer but severely disabling despite well-used acute treatment. Preventives are daily medicines (beta-blockers, candesartan, amitriptyline, topiramate, or newer CGRP treatments via a specialist) judged over two to three months, and the goal is halving the number of attack days.
Can migraines be cured, or prevented without medicine?
Migraine cannot be cured, but attacks can be made rarer and milder. Regularity is the strongest non-drug preventive: fixed sleep and meal times, steady caffeine, hydration, regular exercise, stress management, and avoiding your own triggers from a diary. Acupuncture and riboflavin have modest evidence. Many people find migraines ease with age, and most women improve after the menopause.
Can I treat migraine during pregnancy?
Yes, but the options narrow, so involve a doctor early. Paracetamol is the usual first choice for migraine in pregnancy; anti-inflammatories are limited to specific stages and avoided in the third trimester; triptans are a case-by-case discussion; and preventives such as topiramate are stopped before conception. Most women's migraines improve from the second trimester.
Are migraines linked to periods or contraception?
Often. Falling oestrogen just before a period is a common migraine trigger, and attacks at that time can be longer and harder to treat; a diary confirms the pattern and opens specific options such as short preventive courses around the period. If you have migraine with aura, combined hormonal contraception is unsuitable because of stroke risk; other methods remain available.
- Headaches in over 12s: diagnosis and management (CG150), NICE, National Institute for Health and Care Excellence, 2012, updated 2021.
- The International Classification of Headache Disorders, 3rd edition (ICHD-3), IHS, International Headache Society, 2018.
- Migraine and other headache disorders fact sheet, WHO, World Health Organization, 2024.
- Topiramate: measures to avoid exposure during pregnancy, EMA, European Medicines Agency, 2023.
- Migraine: symptoms, causes and treatments, HSE, Health Service Executive Ireland, accessed August 2026.
- Migraine, NHS, National Health Service (UK), accessed October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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