Migraine Treatment Online — Ireland

About migraine

Migraine is a common primary headache disorder affecting around 12–15% of the Irish population, with women more commonly affected than men (Migraine Association of Ireland data). It's the leading cause of disability for people under 50 worldwide. Most patients can achieve significant symptom reduction with the right combination of acute treatment, preventive strategies, and trigger management.

Symptoms and signs

• Headache — moderate to severe, often unilateral (one-sided), throbbing or pulsating
• Duration — typically 4 to 72 hours if untreated
• Associated symptoms — nausea, vomiting, photophobia (light sensitivity), phonophobia (sound sensitivity)
• Aura in about 25% of patients — visual disturbance (flashing lights, blind spots), sensory symptoms (tingling), or speech disturbance, lasting 5–60 minutes before headache
• Worsened by routine physical activity

Causes and common triggers

Migraine has a strong genetic component. Triggers identified in many patients per NICE CKS: hormonal changes (menstrual migraine), stress, sleep disruption (too little or too much), missed meals, certain foods (chocolate, aged cheese, alcohol — particularly red wine), bright lights or strong smells, weather changes, and medication overuse (rebound headaches).

When to seek help — red flags

An Online Doctor consultation is appropriate for: established migraine where you want to optimise acute treatment, discuss preventive therapy, or rule out medication-overuse headache. Seek urgent care (999/112 or emergency department) for any of: thunderclap headache (worst headache ever, peak in seconds); first severe headache after age 50; headache with fever, neck stiffness, or rash; headache with focal neurological signs (limb weakness, speech disturbance lasting longer than your typical aura, visual loss); headache after head injury; headache that wakes you from sleep or is worse on coughing/straining. These need same-day in-person assessment.

Treatment options — acute

Per NICE stepped guidance:

• Simple analgesia — paracetamol, aspirin, or NSAIDs (ibuprofen, naproxen) taken early in the attack
• Triptans — sumatriptan, rizatriptan, others; first-line specific migraine treatment for moderate-to-severe attacks
• Anti-emetics — for nausea/vomiting (metoclopramide, domperidone)
• Combination treatment — triptan + NSAID often more effective than either alone
• Avoid opioids — not recommended for migraine and increase risk of medication-overuse headache

Treatment options — prevention

Preventive therapy considered if you have 4 or more attacks per month, or attacks significantly affecting quality of life. Options include propranolol, topiramate, amitriptyline, candesartan, or specialist-prescribed CGRP-targeting medications. Each has specific suitability — your Online Doctor will discuss the best fit for you.

Self-care and lifestyle

Keep a headache diary for 2–3 months to identify personal triggers. Maintain regular sleep, meals, and hydration. Manage stress with techniques like mindfulness or CBT. Limit caffeine. Identify medication-overuse risk — taking acute treatment more than 10–15 days a month can paradoxically increase headache frequency. The Migraine Association of Ireland provides patient support resources.

Frequently asked questions

Can a triptan be prescribed online?

Yes — for confirmed migraine in adults without contraindications (uncontrolled hypertension, ischaemic heart disease, history of stroke or significant cardiovascular risk). The Online Doctor will take a full history and review your suitability.

What's medication-overuse headache?

Taking acute headache medication (simple analgesics, triptans, or codeine-containing products) too frequently can cause rebound headaches — a chronic daily headache pattern. Per NICE, the risk increases with use on 10+ days per month for triptans/opioids or 15+ days for simple analgesics. Detoxification under medical guidance reverses this.

Is the contraceptive pill safe for migraine?

Migraine with aura is a contraindication to combined oral contraceptive pills (containing oestrogen) per ICGP and WHO guidance, due to increased stroke risk. Progestogen-only methods are generally safe. Migraine without aura: combined pill may be considered with caution. Discuss with your Online Doctor.

Can children get migraine?

Yes — paediatric migraine is increasingly recognised. Children often have shorter attacks (1–2 hours), more abdominal symptoms, and may have a different pattern from adults. Specific paediatric guidance applies.

Sources: HSE.ie, NICE CKS Migraine, Migraine Association of Ireland, ICGP. General information only.