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  1. Home
  2. Migraine Treatment
  3. Consultation

Your Health

About You

1

Do you believe you have the capacity to make decisions about your own health; and that you do not require help to complete this consultation? *

2

What is your height? *

3

What is your weight? *

4

What is your blood pressure? *

You must have had your blood pressure checked within the last 6 months, and be aware of the results. You are able to get your blood pressure checked at your GP surgery, or your local pharmacy. Can you please let us know what your latest blood pressure reading was. If you have not had your blood pressure checked within the last 6 months, you should have this checked. If you are unsure, please let us know.

Your symptoms

5

Who diagnosed you with migraines? *

6

Have you identified any migraine triggers? *

7

What symptoms do you experience? *

8

How long have you suffered from migraines? *

9

How often do you suffer from migraines? *

10

How many tablets/sprays do you typically use in a month? *

11

How many days in a month do you typically use this medication? *

12

Do you recover fully in between migraine attacks? *

13

Do your migraines follow a similar pattern each time? *

14

Do any of the following apply to you? *

  • You experience a “thunderclap” or explosive headache, loss of vision, or pain in your jaw
  • You have recently had a headache/migraine lasting longer than 72 hours
  • Your headache/migraine have recently gotten worse, the symptoms are changing, or they are not responding to treatment
  • You have recently had a sudden onset of headaches/migraines, reaching maximum intensity within 5 minutes
  • You have experienced loss of consciousness with your headaches/migraines
  • Your headaches/migraines wake you up from your sleep
  • You have recently experienced abnormal reflexes, inability to speak, decreased sensation, loss of balance, mental function problems, vision changes, walking problems, weakness of arms or legs with your headaches/migraines
  • You have recently experienced problems with your memory, learning, perception, or problem solving
  • Your headache/migraine is caused (not made worse) by coughing, sneezing, or exercising
  • Your headache/migraine changes with your posture
  • Your headache/migraine is confined to the back of your head
  • You have experienced fever, fatigue, unintended weight loss, double vision with migraine
  • You have issues with your vision when experiencing a migraine such as pain in your eye, seeing rings around lights, tenderness around the eye, pain in the eye, blurred vision (narrow angle glaucoma symptoms)
  • Your migraine is accompanied by a rash
  • You have trauma to the head and/or neck
  • You are experiencing chest pain and/or shortness of breath
  • You are recovering from drug or alcohol abuse

15

Have you used a triptan medication before? *

A triptan medication is one that belongs to the triptan class, such as sumatriptan, rizatriptan, zolmitriptan 

16

After having used this medication or another migraine relief treatment, have you ever experienced any of the following? *

  • Signs of allergy including rash, hives, wheezing, swollen eyelids, face or lips; or complete collapse
  • Heaviness, pressure, tightness or pain in the chest, throat or other parts of the body
  • Feeling of unusual sensation including numbness, tingling and feelings of warmth and cold
  • Palpitations, flushing, dizziness, feeling of weakness, worsening nausea and vomiting or arise in blood pressure

Your health

17

Do any of the following statements apply to you?

18

Do you suffer from, or have you ever suffered from any of the following? *

  • Heart problems (including angina, heart attacks, high cholesterol, narrowed arteries, problems with the rhythm of your heart)
  • Cramping, numbness or weakness in your legs when walking as a result of poor circulation
  • Any other issues with your circulation such as peripheral vascular disease
  • Stroke or mini-stroke
  • Chest pain
  • Epilepsy or seizures
  • Liver or Kidney problems

19

Do you have any other medical conditions we have not been made of aware of? *

20

Are you pregnant, breastfeeding, planning pregnancy, or at risk of pregnancy whilst taking migraine treatment? *

Your Medication

21

Are you taking any of the following medication? *

  • Certain antidepressants called SSRIs or SNRIs such as citalopram, escitalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine, fluvoxamine, mirtazapine, moclobemide
  • MAOIs (Monoamine Oxidase Inhibitors e.g. phenelzine, selegiline, isocarboxazid, tranylcypromine) which are used to treat conditions such as depression, anxiety, Parkinson’s (includes current use and use within the last 2 weeks)
  • Dapoxetine (includes current use and use within the last 2 weeks)
  • ergotamine or its derivatives
  • Lithium
  • St John’s Wort
  • Other triptan medication used to treat migraines

22

Are you currently taking a combined oral contraceptive pill? *

23

Are you taking any other medication or recreational drugs? *

Please include any medication or drugs you have taken within the last 2 weeks.

24

Do you have any allergies? *

Please ensure to let us know if you have any allergies, especially to medication belonging to the 'sulphonamide' class.

Agreement

25

Is there any additional information that you would like to provide, or any questions you have? *

26

Do you understand that you should seek urgent medical attention if you experience any of the following symptoms? *

  • Paralysis or weakness in one or both arms and/or one side of the face
  • Slurred speech
  • A sudden very intense headache which is worse than your usual headaches
  • If your headache is accompanied by a high temperature, stiff neck, mental confusion, seizures, double vision or a rash

27

Do you understand that? *

  • Triptans are not to be used as a preventative, but only as symptomatic relief
  • If symptoms are NOT reduced after the first dose, you MUST NOT take a second dose for the same attack. In the event of a subsequent attack, a triptan can be taken again after 2 hours (you must fully recover from your first migraine)
  • If you have aura, triptans should be taken at the start of the headache and NOT at the start of the aura (unless the aura and headache start simultaneously)
  • You MUST NOT take more than the maximum dose in any 24-hour period
  • There is a possibility that this medication may affect your ability to drive or operate machinery
  • Using medication for 10 days or more a month can cause a medication overuse headache
  • Avoidance of known triggers and lifestyle changes such as stress management, good sleep hygiene, adequate hydration, regular meals, exercise, and maintenance of a healthy weight can help
  • Feeling tightness in the chest or chest pain shortly after taking a triptan requires urgent medical attention
  • If your migraine persists for longer than 24 hours, you should seek medical attention
  • Medication overuse headache (MOH) is common in people with migraine and can be avoided by restriction of acute medication to a maximum of 2 days per week
  • You should contact us and your GP, if treatment proves to be ineffective. There are alternative routes that can be explored in an attempt to reduce symptoms

28

Do you agree that? *

  • You will read the Patient Information Leaflet with your medication
  • You will contact us and inform your GP if you experience any side effects of treatment, if you start new medication, or if your medical conditions change during treatment.
  • You are over 18 and the treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully and that incorrect information can be hazardous to your health
  • You are aware the decision about your treatment are for both the prescriber and yourself to jointly consider during this consultation, but the final decision will always be the prescriber's.
  • By continuing, you agree to our Terms & Conditions, Cancellation Policy and Privacy Policy