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Medical Assessment for Migraine Relief

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you aged between 18-65?
About Your Symptoms
Are you experiencing any of the following along with your migraine?
  • Unilateral motor weakness
  • Double vision
  • Clumsiness or uncoordinated movements
  • Tinnitus (ringing in the ears)
  • Reduced level of consciousness
  • Seizure-like movements (fits)
  • A recent rash with a headache
  • Headache confined to the back of the head
  • Recent marked deterioration in migraine (duration, severity or frequency of attacks)
Do you experience migraines for more than 10 days a month?
Do your migraines follow a broadly similar pattern each time?
Do your migraines last less than 4 hours without treatment or last longer than 24 hours without treatment?
Your Health Information
Are you breastfeeding, pregnant or possibly pregnant?
Do you have an allergy (hypersensitivity) to Imigran/Sumatriptan, Maxalt/Rizatriptan, Zomig/Zolmitriptan?
Have you been diagnosed with any of the following?
  • Heart disease or heart problems such as narrowing of the arteries (ischaemic heart disease)
  • Chest pains (angina), or have previously had a heart attack
  • Stroke or a mini-stroke (also called a transient ischaemic attack or TIA)
  • High blood pressure
  • Coronary Vasospasm (including Prinzmetal’s angina)
  • Wolff-Parkinson-White Syndrome (a type of abnormal heartbeat)
  • Peripheral Vascular Disease
  • Previous Gastrointestinal or Splenic infarction
  • Ischaemic Colitis
  • Epilepsy or history of seizures
  • Liver problems
  • Kidney problems
  • Allergy or sensitivity to antibiotics called sulphonamides (e.g. trimethoprim)
  • Any serious medical condition which may require immediate hospitalisation
Have you previously been diagnosed with migraines by your GP and have you experienced relief when taking migraine treatments that contained 'triptans' such as Imigran (Sumatriptan), Rizatriptan (Maxalt), or Zomig (Zolmitriptan)?
If you have taken a ‘triptan’ medication in the past, have you experienced any of the following within the first few hours of taking it?
  • Heaviness, pressure or tightness in the body (especially chest or throat)
  • Palpitations
  • Flushing
  • Dizziness
  • Rash
  • Feelings of weakness
  • Worsening nausea and vomiting
  • Temporary rise in blood pressure
Your Current Medication
Are you currently taking any medication (over-the-counter or prescription) or any recreational drugs?
Patient Declaration & Agreements
Do you agree to the following?
  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, you start new medication and/or your medical conditions change during treatment
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully
  • You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber.