Migraine: symptoms, treatment and prevention
A migraine is a severe headache, often throbbing and on one side, that can come with nausea, vomiting and sensitivity to light and sound, and last 4 to 72 hours. By video, the doctor can assess your attacks, recommend treatment and prevention and, if appropriate, prescribe medication. We do not prescribe opioids or other controlled substances.
Can we help by telehealth? Yes, we can help by telehealth.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- The worst headache of your life, or a headache that starts suddenly and peaks very quickly
- Weakness, numbness, trouble speaking or seeing, or loss of balance, especially if you have never had these with a migraine
- Fever with a stiff neck
- A headache after a blow to the head
- Confusion, a seizure or trouble staying awake
Help lines:
- 911 — Emergencies
- 1-800-981-0023 — Línea PAS (mental-health crisis line)
- 988 — Suicide & Crisis Lifeline
- 1-800-222-1222 — Poison Help
Migraine symptoms
Migraine symptoms vary from person to person. The most common are:
- Throbbing head pain, often on one side
- Nausea or vomiting
- Sensitivity to light and sound
- Pain that starts as a dull ache and builds over hours
- Attacks that last 4 to 72 hours
- Tiredness, sweating or loss of appetite
Migraine with aura
Only some people with migraine have an aura. It usually starts 10 minutes to an hour before the headache and lasts no more than an hour. The most common symptoms are vision changes such as dots, zigzag lines or flashing lights; there may also be tingling or trouble speaking. If you have never had these symptoms before, or they are different from usual, get emergency care.
Triggers
Common triggers include too little or changed sleep, stress, cutting out caffeine suddenly, bright lights, loud noise and certain foods. Some people get attacks around their period. Keeping a headache diary helps you find yours.
Treating an attack (no opioids or controlled substances)
Attacks are treated with over-the-counter pain relievers or prescription migraine medicines such as triptans, sometimes with a medicine for nausea. They work best when taken as the pain starts. Resting in a dark, quiet room also helps.
Clinical guidelines advise against opioids for migraine. We do not prescribe opioids or other controlled substances. If appropriate, the doctor can prescribe other medication.
Watch out for medication-overuse headache
Taking pain medicine more than 3 days a week can lead to rebound headaches that keep coming back because of the medicine itself. If you are taking pain relievers that often, tell the doctor: you may need preventive treatment.
Migraine prevention and a headache diary
If you have frequent attacks, daily medicines from several groups can help prevent them (some blood pressure medicines, antidepressants, anti-seizure medicines and medicines that act on CGRP). The doctor will explain which option suits your situation.
Regular sleep and mealtimes, managing stress, and recording your attacks in a diary (when they start, how long they last, what you took) help cut them down and pick the best treatment.
What a video visit can do in Puerto Rico
If you are physically in Puerto Rico, in a US$79 online doctor visit the doctor can assess your headaches, tell you whether the pattern looks like migraine or needs more tests, adjust your treatment, refill prescriptions for non-controlled medicines and give you a sick note after the visit if you need one. For other kinds of headache, see headache.
When to see a neurologist
The doctor may refer you to a neurologist if your headache pattern changes, treatments that used to work stop helping, attacks are very frequent, the pain is worse when lying down, or you have symptoms that need further tests.
Migraine in children and teens
Migraine happens in children too. Young children may not be able to describe sensitivity to light or noise, and may stop playing or want to lie down instead. We see children from 6 months old, with a parent or legal guardian on camera; the doctor is not a pediatrician and will tell you when a pediatric specialist is needed. A severe headache with fever and a stiff neck, or after a blow to the head, is an emergency.
Video visit: US$79 · Pay by card · See the price and what is included
Before you book
- You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
- We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
- Real-time video only; we do not do phone-call visits.
- We do not prescribe controlled substances.
Frequently asked questions
- What helps a migraine?
- Taking your treatment as the pain starts, resting somewhere dark and quiet, and avoiding your triggers. If attacks are frequent, there are preventive treatments. The doctor will tell you which is appropriate for you.
- How long does a migraine last?
- An attack usually lasts 4 to 72 hours. If it lasts longer, or feels different from your usual attacks, get medical care.
- Do you prescribe strong painkillers for migraine?
- We do not prescribe opioids or other controlled substances. If appropriate, the doctor can prescribe migraine-specific medicines and preventive treatment.
- When is a headache an emergency?
- If it is the worst headache of your life, starts suddenly, or comes with weakness, trouble speaking or seeing, confusion, fever with a stiff neck, or follows a blow to the head, call 911.
Sources
- MedlinePlus (NIH): Migraine (accessed 2026-09-30)
- NINDS (NIH): Migraine (accessed 2026-09-30)
- NICE CG150: Headaches in over 12s (accessed 2026-09-30)