What education should be provided to a patient after an urgent‑care visit for migraine?

Patient Education After Urgent Care Visit for Migraine

Every migraine patient discharged from urgent care must receive comprehensive education about their disease, proper medication use including the critical warning about medication overuse headache, and clear instructions on when to seek follow-up care. 1

Core Educational Components

Disease Understanding and Realistic Expectations

• Explain that migraine is a neurological disorder with a biological basis, not a psychological condition, to help patients understand the legitimacy of their condition 1
• Set realistic treatment goals: the objective is returning control from the disease to the patient, reducing attack frequency, duration, and pain intensity to minimize life disruption—not complete elimination of all headaches 1
• Emphasize that migraine is a chronic condition requiring ongoing management, not just acute treatment 1

Medication Instructions and Critical Warnings

The single most important safety message is the risk of medication overuse headache (MOH):

• Warn explicitly that using acute migraine medications ≥10 days per month can cause medication overuse headache, which worsens their condition and creates a chronic daily headache pattern 1, 2
• Instruct patients to limit acute medication use to no more than twice weekly to prevent MOH 3, 4
• Explain that MOH requires withdrawal of overused medications and often causes temporary worsening before improvement 1

For acute medication use:

• Instruct patients to take medications early in the attack when headache is still mild for maximum effectiveness 1
• Provide specific dosing instructions for any prescribed medications 1
• Explain potential adverse effects and what to do about them 1
• If triptans were prescribed or recommended, explain they should not be used during aura phase 1
• Warn about cardiovascular symptoms requiring immediate medical attention: chest pain, shortness of breath, weakness, or slurred speech 2

When to Seek Follow-Up Care

• Schedule or strongly recommend follow-up within 2-3 months to evaluate treatment response and adjust management 1
• Provide clear return precautions for "red flag" symptoms: thunderclap headache, fever with neck stiffness, focal neurological symptoms, altered consciousness, or progressive worsening 1
• Explain that if current treatment fails after adequate trial, alternative medications are available through stepped care approach 1

Lifestyle Modifications and Trigger Management

Avoid overemphasizing trigger avoidance, as this can lead to unnecessary avoidance behavior that damages quality of life 1, 3

Evidence-Based Lifestyle Recommendations

• Maintain regular sleep schedules as poor sleep quality is a major predisposing factor 1, 3, 4
• Engage in regular exercise (40 minutes three times weekly), which is as effective as topiramate or relaxation therapy for prevention 3, 5
• Eat regularly and maintain adequate hydration 3
• Address obesity if present, as it is the single most critical modifiable risk factor for transformation to chronic migraine 3, 4

Trigger Factor Education

• Explain that true trigger factors are often self-evident and don't require extensive investigation 1
• Distinguish between aggravating factors (worsen headache during attacks, like physical activity) and predisposing factors (increase susceptibility, like poor sleep) 1
• For women, note that menstruation is an important exception as a well-established trigger 1

Headache Diary and Self-Monitoring

• Provide or recommend a headache diary to track attack frequency, severity, medication use, and potential triggers 5, 4
• Explain this diary is essential for monitoring treatment response and identifying medication overuse patterns 5
• Encourage recording headache days per month to determine if preventive therapy becomes necessary 1, 5

Indications for Preventive Therapy

• Explain that preventive therapy should be considered if migraine adversely affects them ≥2 days per month despite optimized acute treatment 1, 5
• Note that preventive medications require 2-3 months for adequate trial before determining effectiveness 1
• Mention that multiple effective preventive options exist if acute treatment alone proves insufficient 1

Comorbidity Awareness

• Screen for and educate about common comorbidities: depression, anxiety, sleep disorders, and chronic pain conditions 1, 5, 4
• Explain that managing these comorbidities directly improves migraine outcomes 5, 4
• Recognize that these conditions are 2-3 times more prevalent in chronic versus episodic migraine 4

Discharge Prescriptions and Recommendations

Common pitfall in urgent care settings: Only 11.1% of patients without previous triptan use receive triptan prescriptions at discharge, and less than half with nausea receive anti-emetic prescriptions 6

• Provide triptan prescription (if not contraindicated) for home use during future attacks, as most urgent care patients have episodic migraine amenable to outpatient management 6
• Consider prescribing anti-emetics for patients with nausea/vomiting during attacks 1, 6
• Provide NSAIDs (ibuprofen, naproxen, or diclofenac) as first-line acute treatment 1, 5
• Consider short course of corticosteroids to reduce headache recurrence risk in the 24-72 hours post-discharge 7

Referral Indications

Educate patients they should seek specialist headache care if they experience:

• Chronic migraine (≥15 headache days per month) 1, 5
• Failure of multiple preventive medications 1, 5
• Diagnostic uncertainty or atypical features 1, 5
• Need for advanced therapies like Botox or CGRP antibodies 5