Consult a neurologist online for migraine: medical assessment and an individualised treatment plan

Migraine pain is often throbbing and may be concentrated on one side of the head, although it does not always present in the same way. An episode may also involve nausea, vomiting and increased sensitivity to light or sound.

Symptoms of migraine with aura may include flashes of light, blind spots, zigzag lines or other visual disturbances. Tingling sensations or difficulty finding words can also occur.

Some people notice changes in the hours or even days before an attack. Tiredness, mood changes, yawning or neck stiffness may be part of this early phase.

There is no single cause of migraine. Genetic predisposition appears to play an important role, and changes in certain chemical mechanisms in the nervous system, including those involving serotonin, have also been studied.

Attacks may be triggered or made more likely by a range of factors, including hormonal changes, stress, lack of sleep, skipping meals, dehydration, bright light, strong smells or alcohol. Certain foods, such as aged cheeses or chocolate, may also act as triggers for some people. This does not mean that foods should be eliminated from the diet as a general rule. There is no universal list of foods to avoid with migraine with aura: it is usually more helpful to notice whether a particular food is repeatedly associated with your attacks and discuss this with a healthcare professional.

For this reason, the possible causes of migraine with aura and its triggers should be assessed individually.

Migraine attacks do not all present in the same way. Understanding the different patterns can help you describe your symptoms more clearly during a consultation, although identifying the specific type requires a medical assessment.

Migraine with aura is characterised by reversible neurological symptoms that may occur before the headache or alongside it. Visual disturbances are common, but sensory symptoms or language difficulties can also occur. The key feature is the presence of these neurological symptoms in association with the attack.

When visual symptoms predominate, you may notice flashes, zigzag lines or areas of altered vision, which can vary from person to person. These symptoms can occur as part of migraine with visual aura.

Retinal migraine is different because the visual changes affect only one eye. Vestibular migraine can also occur, with vertigo, dizziness or balance problems sometimes being more prominent than headache. Vestibular migraine treatment may include different options, which should be considered according to each patient’s individual presentation.

Chronic migraine is characterised by headache on at least 15 days per month over prolonged periods. Hemiplegic migraine, on the other hand, can involve weakness on one side of the body and may share symptoms with a stroke. If new or severe neurological symptoms develop, you should not try to determine on your own whether they are caused by migraine or stroke; urgent medical assessment is needed.

The measures used to manage an attack depend on its severity, frequency and characteristics. For mild attacks, some patients use common painkillers such as ibuprofen or paracetamol, taking their medical history and a healthcare professional’s advice into account.

When attacks are more severe, the doctor may consider migraine medications, including triptans. Medicines such as sumatriptan may form part of treatment when the clinician considers them appropriate for the patient.

During an attack, it may also help to rest in a quiet, dark room, reduce exposure to stimulation, stay adequately hydrated and use relaxation techniques. These measures do not replace medical assessment when attacks are frequent or difficult to control.

If attacks occur frequently, last a long time or significantly interfere with daily life, the doctor may consider a preventive strategy. A migraine treatment plan may focus not only on relieving an individual attack but also, where possible, on reducing the frequency or severity of future attacks.

It is advisable to seek medical assessment when episodes occur frequently, for example more than four times a month, when they progressively become more severe, or when the measures that usually help are no longer effective.

You should also consider seeking medical advice if attacks begin to affect work, studies, sleep or everyday activities. An assessment allows the doctor to review how often the episodes occur and decide whether the treatment approach should be adjusted or preventive measures considered. New symptoms require particular attention. Sudden visual disturbances, weakness, difficulty speaking, confusion, loss of consciousness or a sudden, extremely severe headache require urgent assessment.

Having a familiar pattern of aura does not by itself rule out a stroke. If symptoms are new, different from your usual symptoms or otherwise concerning, it is safer to seek immediate medical attention.

Migraine management may involve different strategies depending on how often attacks occur, their characteristics and the impact they have on daily life. A doctor may recommend measures to use at the start of an attack and, when necessary, consider a preventive approach.

Options a clinician may consider include triptans for certain attacks and beta blockers as one of the medicines that can be used for prevention. The choice depends on the clinical situation, medical history, other medications and possible contraindications.

Keeping a record of your attacks can also support the assessment. Noting when the pain starts, how long it lasts, which symptoms accompany it and what circumstances were present can help identify individual patterns and assess how well different measures are working.

Not every patient needs preventive medication, and people do not all respond in the same way to a particular option. The aim is to work with the clinician to find an appropriate strategy for each person and adjust migraine treatment when necessary.

Oladoctor provides access to clinicians who can assess headache-related concerns and advise on appropriate next steps. The platform includes professionals in general medicine, family medicine and pain medicine, as well as other clinicians according to current availability.

You can choose a clinician based on the type of care you need and the availability shown on the platform. During the consultation, you can explain how your episodes have developed, any associated symptoms and the measures or treatments you have tried previously.

If the doctor considers that your case requires specialist assessment, an in-person examination or additional tests, they will advise you on the most appropriate option.

An online consultation gives you time to explain your episodes clearly and share relevant clinical information without travelling to an in-person appointment initially. The clinician will review the available information and decide whether your situation can be managed remotely.

The main benefits of the service include:

• Explaining the frequency, duration and characteristics of your episodes.
• Sharing your medical history and treatments you have used previously.
• Consulting professionals in general medicine, family medicine or pain medicine who are available on the platform.
• Receiving individual recommendations on how to manage your episodes.
• Considering preventive strategies when attacks are frequent.
• Receiving a prescription only when the doctor considers that there is a clinical indication.
• Being advised to arrange an in-person consultation or additional tests when the situation requires it.

Oladoctor aims to make medical assessment easier to access and help determine the appropriate next steps. The consultation does not guarantee a diagnosis or the prescription of a specific medication.