Online migraine assessment
Migraine is more than a headache — and it deserves a proper clinical assessment. Our doctors registered with the Ordem dos Médicos assess your pattern of headaches, triggering factors, and medical history by secure video call, and advise on treatment and prevention.
Migraine or ordinary headache?
There are several types of headache. The most common is tension-type headache: a milder pain that feels like tightness and does not usually stop you from working. Migraine is different. According to the WHO, it comes in attacks that usually last between 4 and 72 hours and are accompanied by nausea, vomiting and sensitivity to light and noise.
The pain is usually throbbing, often on only one side of the head, and gets worse when you move. Before the pain, some people feel tired, yawn a lot, crave certain foods or notice changes in mood. After the attack, it is common to feel exhausted for a day or two.
Migraine is more common in women and often starts in adolescence or early adulthood.
Migraine with aura
Some people have warning signs before the pain, known as aura. The most common are:
- flashing lights, zigzag lines or blind spots in your vision
- numbness or tingling, like pins and needles
- dizziness
- difficulty speaking
According to SNS 24, aura lasts between 5 and 60 minutes. If the aura is new or different from usual, if it lasts more than an hour or if you have weakness on one side of your body, seek urgent medical assessment to rule out other causes.
What triggers an attack
The exact cause of migraine is still not known. The WHO lists alcohol, changes in sleep and certain foods as common triggers. Many people also recognise stress, skipping meals, not drinking enough water or their period. Triggers vary a great deal from person to person, so it is worth recording your attacks in a diary for a few weeks: date, duration, symptoms, what you were doing and what medicines you took.
Treating attacks without overusing painkillers
Migraine has no cure, but treatment can make attacks less frequent and easier to control. During an attack, it helps to rest in a dark, quiet room and drink water.
- Painkillers and anti-inflammatories available over the counter (such as paracetamol or ibuprofen) work best when taken at the first signs, as the WHO recommends.
- Triptans, medicines specifically for migraine, require a doctor's recommendation.
- Antiemetics help with nausea and vomiting.
Be careful with how often you take them. Taking painkillers too often can cause medication-overuse headache, which the WHO describes as the most common secondary headache. If you need painkillers on many days a month, talk to a doctor.
When attacks are frequent, a daily preventive treatment may make sense. SNS 24 includes, among the preventive options, anti-CGRP antibodies and botulinum toxin type A, the latter mainly in chronic migraine, that is, headache on 15 or more days a month for more than 3 months. These treatments are directed by neurology.
What an online doctor can and cannot do
Migraine is diagnosed mainly from the medical history, so a video consultation is a good starting point. The doctor can:
- take a detailed history and review your attack diary
- tell you whether the pattern fits migraine or another type of headache
- advise on treating attacks and on prevention, and recommend treatment when clinically appropriate
- work out whether you are overusing painkillers
- refer you to neurology when the diagnosis is unclear or treatment is not working
What video does not allow is a full neurological examination (vision, coordination, reflexes, sensation). If the doctor thinks one is needed, they will tell you clearly where you should go.
Is this a new or occasional migraine, or do you have migraines frequently?
For a new or occasional migraine, start with a general practice consultation.
For chronic or frequent migraines that require ongoing follow-up, our General and Family Medicine consultation provides a long-term management plan.
General and Family Medicine Consultation
When symptoms suggest a need for specialist assessment or tests, we coordinate referral to neurology.
Chronic migraine: when the pain comes almost every day
SNS 24 speaks of chronic migraine when there is headache on 15 or more days a month for more than 3 months. This is a different situation from occasional attacks and needs its own plan.
One of the routes to chronic migraine is taking painkillers almost every day. The WHO describes medication-overuse headache as the most common secondary headache, and it is fuelled by the very treatment used for the attacks. That is why the first step is to count the days with pain and the days with medication over one month.
With that record, the doctor can suggest a preventive treatment, review how you treat your attacks and, when justified, refer you to neurology, where options such as botulinum toxin or anti-CGRP antibodies are decided. In our General and Family Medicine consultation, follow-up is ongoing: the same doctor reviews your diary, the effect of treatment and any side effects over the months.
When to book an appointment
Talk to a doctor, online or in person, if:
- your attacks are severe, getting worse or lasting longer than usual
- you have attacks more than once a week
- you feel you cannot control your migraine
- attacks regularly come on before or during your period
Attacks linked to periods, known as menstrual migraine, are usually longer and more intense than others. In women, migraine often improves after the menopause and sometimes during pregnancy. In most people, attacks become milder with age.
When it is an emergency
SNS 24 advises calling 112 if you, or someone else, have:
- a sudden, very severe headache, unlike any previous one
- altered consciousness, drowsiness or confusion
- sudden difficulty speaking
- loss of strength or sensation in an arm, a leg or one side of the face
- a significant change in vision
- a fever that is getting worse, especially with a stiff neck
The NHS adds a seizure and a headache after a blow to the head. Talk to a doctor urgently if an attack lasts more than 72 hours, if the aura lasts more than an hour, or if you have an attack during pregnancy or shortly after having a baby. If in doubt, call the SNS 24 helpline (808 24 24 24), which assesses the situation and tells you where to go.
Sources
- Migraine and other headache disorders (WHO)
- Migraine (NHS)
- Enxaqueca (SNS 24)
- Migraine (overview) (HSE)
- Diagnosing migraine (HSE)
- Sobre nós (Linha SNS 24, 808 24 24 24) (SNS 24)
- Combined pill, who can take it (NHS)