Red Flags & When to Go In Person for Migraine

Audience: adult

Migraines are common headaches that can cause intense pain, nausea, and sensitivity to light or sound. Many people manage migraines at home or with the help of telemedicine. However, some symptoms may signal a more serious problem that needs in-person medical care. This guide helps you understand the warning signs, or "red flags," that mean you should see a healthcare provider in person. Telemedicine can often help with routine migraine management, medication advice, and follow-up care. But if your symptoms change suddenly, worsen, or come with other concerning signs, it is important to get evaluated face-to-face. Knowing when to seek urgent care can help prevent complications and ensure you get the right treatment. Always trust your instincts and seek emergency care if you feel very unwell.

Red flags — go in person / ER

• Sudden, severe headache unlike previous headaches (thunderclap headache) – go to emergency care immediately.
• New neurological symptoms such as weakness, vision changes, confusion, or difficulty speaking – seek urgent in-person evaluation.
• Headache with fever and stiff neck – seek emergency medical care promptly.

What telemedicine can do

• Routine migraine symptom assessment and follow-up
• Medication management and prescription adjustments
• Lifestyle and trigger management advice
• Education about migraine and self-care strategies

What telemedicine cannot do

• Evaluation of sudden, severe headache or "worst headache of life"
• New neurological deficits or changes in mental status
• Headache after head trauma
• Signs of infection such as fever with stiff neck
• Severe vomiting leading to dehydration

What Is a Migraine?

A migraine is a type of headache that usually causes severe throbbing or pulsing pain, often on one side of the head. It can last from a few hours to several days. Many people with migraines also feel sick to their stomach, vomit, or are very sensitive to light and sound. Migraines can interfere with daily activities but often improve with rest and medication.

When Can Telemedicine Help?

Telemedicine can be a good option for managing migraines, especially if you have a known history. A healthcare provider can talk with you about your symptoms, suggest treatments, adjust medications, and provide advice on lifestyle changes. Telemedicine visits are helpful for routine follow-up and when symptoms are typical and stable.

Red Flags: When to Seek In-Person Care

Some migraine symptoms may signal a more serious condition. You should seek in-person medical care if you experience:

These signs require prompt evaluation to rule out serious problems like stroke, infection, or brain injury.

Preparing for Your Telemedicine Visit

To get the most from your telemedicine appointment, prepare by:

After Your Telemedicine Visit

After your appointment, follow your provider's instructions carefully. This may include:

If you do not feel better or symptoms worsen, do not hesitate to get urgent medical attention.

How to prepare for your tele-visit

• Write down details about your migraine history, including frequency, duration, and triggers.
• List all current medications and supplements.
• Note any new or worsening symptoms since your last visit.
• Find a quiet, private space with good internet connection for the visit.
• Have a family member or friend nearby if you feel unwell or may need help during the appointment.

After your tele-visit

• Follow the treatment plan and medication instructions provided by your healthcare provider.
• Keep a headache diary to track symptoms and triggers.
• Schedule follow-up telemedicine or in-person visits as recommended.
• Seek immediate in-person care if red flag symptoms develop.
• Contact your healthcare provider if your symptoms worsen or do not improve as expected.

FAQs

Can telemedicine diagnose a new migraine?

Telemedicine can help assess symptoms and suggest if they fit the pattern of migraines. However, if your headache is new, very severe, or different from past headaches, an in-person evaluation may be needed to rule out other causes.

When should I go to the emergency room for a headache?

Go to the emergency room if you have a sudden, severe headache (often described as the worst headache ever), new neurological symptoms like weakness or vision loss, headache after a head injury, or fever with stiff neck. These could be signs of serious conditions.

Can telemedicine providers prescribe migraine medications?

Yes, telemedicine providers can often prescribe medications for migraine management. They will consider your medical history and symptoms to choose safe and effective treatments.

What if my migraine symptoms get worse after a telemedicine visit?

If your symptoms worsen, especially if you develop any red flag signs, seek in-person medical care promptly. Telemedicine is not a substitute for emergency or urgent evaluation when needed.

Sources

1. Migraine — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Migraine Overview — Mayo Clinic.
3. Headache: When to Seek Emergency Care — Centers for Disease Control and Prevention (CDC).
4. Migraine Treatment — Merck Manuals: Consumer Version.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If you experience any red flag symptoms or feel your condition is urgent, seek immediate medical attention in person.