Preparing for Appointments with Migraines or Headaches

Migraines and chronic headaches affect approximately one in seven people worldwide, yet many patients arrive at their GP or neurology appointment without the structured information their clinician needs most. Headache diagnosis is almost entirely history-based — there is no blood test or scan that diagnoses migraine. What your doctor needs is a detailed pattern: how often, how severe, how long, what helps, and what triggers each episode.

The preparation you do in the weeks before your appointment — particularly a headache diary — has a direct impact on the quality of the plan you leave with.

1. Why a Headache Diary Is the Foundation of Your Appointment

A headache diary does more than record pain. It reveals patterns your memory cannot reliably reconstruct over weeks or months, and it gives your clinician objective frequency data for treatment decisions.

What to record for each headache episode:

• Date and start time — and the time the headache ended
• Pain severity — score from 1 (mild) to 10 (worst imaginable)
• Location and quality — one side or both, throbbing or pressure, frontal or posterior
• Associated symptoms — nausea, vomiting, sensitivity to light or sound, any aura (visual disturbances, speech changes, numbness)
• Possible triggers — sleep changes, skipped meals, alcohol, stress, menstrual cycle, weather change, screen time
• Medication taken — what you took and whether it helped

Track daily — even headache-free days are important because your doctor will want to know your baseline. Keeping a structured journal with dated daily entry fields helps you build this log without relying on memory. A medical appointment journal, like this one, with structured prompts for symptoms, medication notes, and questions to ask, makes this systematic. (Affiliate link — we may earn a small commission at no extra cost to you.)

2. What Information to Bring to Your Appointment

Beyond your headache diary, prepare the following before your appointment:

Medication list (current and past):

• All medications currently used for headaches — prescription and over-the-counter — with dosages and frequency per week
• Any preventive medications tried previously and whether they helped or caused side effects
• All other medications and supplements (some affect migraine threshold or interact with treatments)

Your headache history:

• When headaches first started and whether their character has changed over time
• Family history of migraines (migraine has a strong genetic component)
• Any previous brain imaging or specialist consultations and their outcomes
• For women: whether headaches are linked to the menstrual cycle, contraceptive use, or hormonal changes

Impact on your life:

• How many days per month do headaches affect your ability to work, study, or carry out daily activities?
• Have you missed work or school because of headaches in the past three months?

3. Medications — Current and Previous Treatments

Bring every headache medication you use — not just prescription items. Over-the-counter analgesics taken frequently are a critical data point for your clinician.

Medication overuse headache (MOH) is one of the most commonly missed diagnoses in patients with chronic daily headache. It occurs when acute headache medications — including paracetamol, ibuprofen, triptans, and combination analgesics — are used on more than 10 to 15 days per month. MOH causes the very headaches patients are trying to treat and is entirely reversible once identified. Your doctor cannot assess for MOH without accurate medication frequency data.

Do not stop any medication before your appointment without guidance. Withdrawal from some headache medications must be managed clinically to avoid rebound.

4. What Your Doctor Will Examine

For a new headache presentation, your GP or neurologist will typically:

• Take a detailed headache history — the structured questions will cover onset, duration, character, severity, associated features, and triggers. Your diary makes this far more precise.
• Perform a neurological examination — checking vision, eye movements, coordination, reflexes, and sensation to identify any neurological abnormality (red flag features that would prompt imaging).
• Assess blood pressure — hypertension can cause or worsen headaches.
• Screen for red flag features (sometimes called “SNOOP4” criteria): sudden severe onset (“thunderclap”), systemic symptoms (fever, weight loss), neurological signs, onset after age 50, positional component, progressive worsening, or precipitation by Valsalva manoeuvre (coughing, straining).

If no red flag features are present and your history is consistent with migraine or tension headache, no brain imaging is routinely required. Most headache diagnoses are made clinically.

5. Headache Classification and Treatment Overview

Understanding the main headache categories helps you follow your doctor’s explanation:

• Migraine without aura: Recurrent attacks of moderate to severe unilateral throbbing pain lasting 4–72 hours, with nausea and/or photophobia/phonophobia. The most common migraine type.
• Migraine with aura: As above, preceded by reversible neurological symptoms (visual disturbances, speech changes, sensory changes) lasting 20–60 minutes.
• Tension-type headache: Bilateral pressing pain, mild to moderate severity, no nausea, no worsening with activity. The most prevalent headache type overall.
• Chronic migraine: Migraine features on 15 or more days per month for more than three months. Preventive treatment is almost always indicated.
• Cluster headache: Severe unilateral pain around the eye, 15–180 minutes, with autonomic features (tearing, nasal congestion, eyelid drooping). Requires specialist evaluation and specific treatment.

Treatment options your doctor may discuss:

• Acute (attack) treatment: NSAIDs, paracetamol, triptans (e.g. sumatriptan, rizatriptan), antiemetics for nausea
• Preventive treatment: Propranolol, amitriptyline, topiramate, sodium valproate (for eligible patients), or newer CGRP antagonists (erenumab, fremanezumab, galcanezumab)
• Non-pharmacological: Regular sleep schedule, hydration, trigger identification, CBT-based pain management, biofeedback

6. Regional Context: Headache and Migraine Care

• Singapore: GPs at polyclinics manage most uncomplicated migraine and tension headache. Referral to a neurologist (via restructured hospital outpatient or private) is appropriate for atypical features, diagnostic uncertainty, or inadequate response to initial treatment. Common preventive medications are available on the CHAS subsidy scheme. Private neurology consultation typically costs SGD 150–300 per visit.
• Australia: Your GP is the first contact for headache assessment. Neurologist referral is Medicare-rebated. Preventive CGRP antagonists (erenumab, fremanezumab) became PBS-listed for eligible chronic migraine patients — ask your neurologist about eligibility criteria. Headache Australia (headacheaustralia.org.au) provides patient education resources.
• United States: Primary care physicians (PCPs) manage most migraines. Neurologist referral is appropriate for complex or refractory cases. CGRP antagonists are covered by most major insurance plans with prior authorisation for chronic migraine. The American Migraine Foundation patient resources are available at americanmigrainefoundation.org.

7. Questions to Ask Your Doctor

• Based on my diary, what type of headache do you think I have — and what is the diagnostic criteria you are using?
• Do any of my symptoms suggest I need a brain scan, and if so, what would it be looking for?
• How frequently am I using acute medication, and do you think I may have medication overuse headache?
• Would preventive treatment be appropriate for me given my frequency and disability level?
• Are there specific triggers in my diary that I should actively work to reduce?
• What symptoms should prompt me to seek emergency care rather than treating at home?

Medical Disclaimer: This guide is for preparation and informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always follow the guidance of your qualified healthcare provider. For medical emergencies, call 995 (SG) · 000 (AU) · 911 (US) · 111 (NZ).