Migraine Mode

Take Self-Assessment Referral form

TREATMENT DISCUSSION GUIDE

Treatments taken over the past year

What migraine or headache treatments have you taken over the past year?

Please list treatments taken to relieve your headaches or migraines after they started, including over-the-counter and prescription medication. If you've taken more than 5, list the ones taken most frequently.

1

2

3

4

5

Please list treatments taken to prevent your headaches or migraines (preventative treatments). If you've taken more than 5, list the ones taken for the longest period of time.

1

2

3

4

5

Acute treatment experience

Preventative treatment experience

Get your responses and share them with your doctor.

Print Response