Migraine: symptoms, treatment and prevention by video in Puerto Rico

A migraine is a kind of headache that comes in attacks. The pain often starts as a dull ache and builds over hours, and it can stop you in your tracks. Some people get an aura first: it usually starts 10 minutes to an hour before the headache and lasts no more than an hour, with vision changes such as dots, zigzag lines or flashing lights, and sometimes tingling or trouble speaking.

Migraine comes and goes over years, so it works best with a plan: treat each attack well, prevent attacks if they are frequent, and keep up with follow-up.

Booking is simple:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, with a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If you only need a refill of a migraine medicine you already take (non-controlled), choose the follow-up visit: anyone can book it. A review of lab results is also a follow-up visit, for existing patients. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

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
• Aura: vision changes before the headache
• Tiredness, sweating or loss of appetite

For an attack. 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.

Triptans: sumatriptan and rizatriptan. These prescription medicines stop a migraine attack once it has started; according to MedlinePlus, they do not prevent attacks or reduce how many you have. You take them at the first sign of pain. They are not for everyone: according to the FDA-approved label, they are not used if you have coronary artery disease, uncontrolled high blood pressure, a past stroke or mini-stroke, hemiplegic or basilar migraine, peripheral vascular disease, certain heart-rhythm problems, ischemic bowel disease or severe liver disease, among others, or within 24 hours of another triptan or an ergot medicine, or if you took an MAO-A inhibitor in the last 2 weeks. That is why the doctor reviews your history, your blood pressure and your other medicines, antidepressants included, before deciding.

For prevention. If you have frequent attacks, daily medicines from several groups can help prevent them (some blood pressure medicines, such as propranolol; antidepressants, such as amitriptyline; anti-seizure medicines; and medicines that act on CGRP). The doctor explains which option suits you.

Watch the painkillers. Taking pain medicine more than 3 days a week can lead to rebound headaches. If you are taking it that often, tell the doctor: it may be time for preventive treatment.

Lab tests. Migraine is diagnosed from your symptoms, with no special test. If the doctor wants to rule out another cause or check something before starting a medicine, she gives you a lab order for a lab near you and goes over the results with you. If needed, she guides you to a neurologist.

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. Regular sleep and mealtimes, and a diary of your attacks (when they start, how long they last, what you took), help cut them down and help the doctor pick the best treatment.

Migraine happens in children too, and we see children of all ages. Young children may not be able to describe sensitivity to light or noise; they may stop playing or want to lie down instead. The doctor evaluates your child by video with you on camera and explains how to treat and prevent their attacks. For their safety, a severe headache with fever and a stiff neck, or after a blow to the head, is an emergency.

For your safety, call 911 or go to the emergency room if you have any of these signs. More in when to go to the ER.

• The worst headache of your life, or a thunderclap headache: it starts suddenly and peaks within 5 minutes
• Weakness, numbness, trouble speaking or seeing, especially if you have never had these before
• Fever with a stiff neck
• A headache after a blow to the head
• Confusion, a seizure or trouble staying awake