Migraine Treatment: When to See a Doctor and What Helps
This guide is part of Abby Health’s clinical education series. It is contributed to by our GPs in the Abby Health care network, written with reference to Headache Australia, RACGP clinical guidelines, Healthdirect Australia, and the Therapeutic Goods Administration (TGA). It is general information only and not a substitute for a consultation with a registered medical practitioner.
The exact cause of migraine is not fully understood, but research has advanced significantly in recent decades. What is known is that migraine is a neurological condition involving changes in brain activity, nerve signalling, and blood flow. It is not simply a bad headache. It is a complex neurological event that can affect the entire body.
Migraine tends to run in families. According to the Brain Foundation Australia, people with a first-degree relative who experiences migraine are significantly more likely to develop the condition themselves. Genetic factors influence how the brain responds to certain triggers and how pain pathways are activated.
At the neurological level, current research suggests that migraine involves the activation of the trigeminovascular system, a network of nerves and blood vessels that plays a central role in head pain. During a migraine, these nerve pathways become overactive, releasing inflammatory chemicals that irritate blood vessels and surrounding tissues. This process is thought to be responsible for the throbbing, often one-sided pain that characterises many migraine attacks.
Several factors are known to trigger migraine episodes in people who are predisposed. Common triggers include:
- Hormonal changes — Fluctuations in oestrogen are one of the most well-documented triggers. Many women report migraines occurring around menstruation, during perimenopause, or in response to hormonal contraception. Healthdirect Australia notes that hormonal migraine is one of the reasons the condition disproportionately affects women.
- Stress and fatigue — Both physical and emotional stress can trigger an attack. Paradoxically, the onset of relaxation after a period of intense stress (sometimes called a "let-down" migraine) is also a recognised pattern.
- Dietary factors — Certain foods and drinks, including alcohol (particularly red wine), aged cheeses, processed meats, and foods containing MSG, have been identified as triggers in some individuals. Skipping meals or not drinking enough water may also contribute.
- Environmental stimuli — Bright or flickering lights, strong smells, loud sounds, and changes in weather or barometric pressure are all reported triggers.
- Sleep disruption — Both too little and too much sleep can increase the likelihood of an attack. Irregular sleep patterns are a particularly common trigger in shift workers and new parents.
- Medication overuse — Taking pain relief too frequently (typically more than 10 to 15 days per month, depending on the type of medication) can lead to a rebound pattern known as medication overuse headache, which worsens migraine frequency over time.
It is worth noting that triggers are highly individual. What provokes a migraine in one person may have no effect on another. Keeping a headache diary, which tracks the timing, severity, duration, and potential triggers of each attack, can be a useful tool for identifying personal patterns. A GP who knows your full health story can help interpret this information and use it to guide long-term treatment.
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Many people use the word "migraine" loosely to describe any severe headache, but the two conditions are clinically distinct. Understanding the difference matters because the treatment approach for each is not the same.
A tension-type headache, which is the most common form of headache, typically presents as a dull, constant pressure or tightness on both sides of the head. It may feel like a band around the forehead. Tension headaches are usually mild to moderate in intensity, do not worsen with physical activity, and are not accompanied by nausea or sensitivity to light and sound. They respond well to simple analgesics and tend to resolve within a few hours.
A migraine attack is a different experience. According to the International Classification of Headache Disorders (ICHD-3) referenced by Healthdirect Australia, a migraine episode typically involves:
- Moderate to severe pain, often on one side of the head (though it can be bilateral)
- A pulsating or throbbing quality to the pain
- Nausea and/or vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
- Worsening with routine physical activity, such as climbing stairs or bending over
- Duration of 4 to 72 hours if untreated
About one in four people with migraine also experience aura, a set of neurological symptoms that typically develop 5 to 60 minutes before the headache phase begins. Aura most commonly involves visual disturbances such as zigzag lines, flashing lights, or blind spots in the visual field. Less commonly, it can include tingling or numbness in the face or hands, difficulty speaking, or a sense of confusion. Aura symptoms are temporary and fully reversible, but they can be alarming for someone experiencing them for the first time.
There are also less common migraine subtypes, including migraine without headache (sometimes called "silent migraine"), vestibular migraine (where the primary symptom is dizziness or vertigo rather than head pain), and chronic migraine (defined as 15 or more headache days per month, with at least eight of those meeting migraine criteria). A GP or specialist can help distinguish between these subtypes and recommend an appropriate treatment path.
The key point is this: if headaches are recurring, one-sided, throbbing, and accompanied by nausea, light sensitivity, or aura, it is worth discussing with a doctor. What many people dismiss as "just a headache" may be migraine, and migraine has its own set of treatment options that go well beyond standard pain relief.
Acute treatment refers to medication and strategies used to manage a migraine attack once it has started. The goal is to reduce severity and duration and restore the ability to function. NPS MedicineWise and Australian Therapeutic Guidelines (eTG) emphasise that treating early — at the first sign of an attack, before pain becomes severe — significantly improves outcomes for many patients.
Selecting the right medication, dose, and timing is a clinical decision made by a registered medical practitioner. Nothing in this article is a recommendation to take a specific medication. A GP will weigh the patient's history, the frequency and severity of attacks, cardiovascular risk, pregnancy status, other medications, and individual contraindications before determining what is appropriate.
Over-the-counter options
For mild to moderate attacks, simple analgesics may provide relief:
- Paracetamol — generally well tolerated and can be effective when taken early, though it may be insufficient for moderate to severe attacks.
- Non-steroidal anti-inflammatory drugs (NSAIDs) — a class of over-the-counter and prescription medications that have shown benefit in acute migraine. Soluble or fast-dissolving formulations may be absorbed more quickly during an attack, when gastric motility is often slowed.
- Combination analgesics — some products combine paracetamol or aspirin with caffeine. Frequent use of caffeine-containing analgesics carries a risk of medication overuse headache and should be discussed with a GP.
Prescription classes used for acute migraine
When over-the-counter treatments are insufficient, a GP may consider prescription options. The Royal Australian College of General Practitioners (RACGP), Australian Therapeutic Guidelines (eTG), and NPS MedicineWise set out the main classes used in acute migraine care:
- Migraine-specific serotonin receptor agonists — a prescription class developed specifically for migraine that acts on serotonin pathways involved in the migraine mechanism. These medicines are generally most effective when taken early in an attack. They are not suitable for every patient, particularly those with certain cardiovascular conditions, and selection requires clinical assessment.
- Newer migraine-specific classes — additional prescription classes targeting specific migraine pathways have become available in recent years. Eligibility and access criteria apply.
- Anti-emetic medications — nausea is a common feature of migraine and can interfere with the ability to keep oral medication down. A GP may prescribe an anti-emetic to be taken alongside an analgesic or migraine-specific medication.
- Prescription NSAIDs — some NSAIDs available only on prescription, including in soluble or injectable forms, may be considered for more severe attacks.
Australia's Therapeutic Goods Administration (TGA) requires prescription medicines to be used only under the advice of a registered medical practitioner. A GP will decide the specific agent, dose, and duration at the point of consultation — this article does not recommend or name specific medicines. A responsible online-first clinic is not a drive-thru for prescriptions. The clinician's role is to assess whether a prescription is genuinely appropriate, select an agent where indicated, and arrange review if symptoms do not respond.
Non-medication strategies
Some non-pharmacological approaches may support medication rather than replace it:
- Resting in a dark, quiet room
- Applying a cold pack to the forehead or back of the neck
- Staying hydrated
- Slow, controlled breathing or relaxation techniques
If vomiting is preventing oral medication from being kept down, a clinical review is warranted. Headache Australia notes that attacks accompanied by persistent vomiting, severe or sudden-onset headache, or neurological symptoms such as weakness or visual loss warrant prompt medical attention.
For people with frequent migraine — particularly four or more attacks per month, or attacks that are severe and disabling — preventive treatment may be worth discussing with a GP. The aim of preventive therapy is to reduce frequency, severity, and duration over time. It does not typically eliminate migraine, but it can make a meaningful difference to quality of life.
The decision to start preventive treatment is clinical, made in partnership between patient and doctor. Factors that prompt the conversation include:
- Four or more attacks per month
- Attacks that are severe and disabling despite acute treatment
- Overuse of acute medication (a trigger for medication overuse headache)
- Significant impact on work, relationships, or daily activities
- Certain migraine subtypes, such as hemiplegic migraine or migraine with prolonged aura
Medication classes used for migraine prevention
Several classes of medication have evidence supporting their use in migraine prevention, as set out by the Royal Australian College of General Practitioners (RACGP) and NPS MedicineWise. Choice is individualised and depends on age, comorbidities, pregnancy status, other medications, and individual tolerability:
- Beta-blockers — a cardiovascular medication class that has shown benefit in migraine prevention and is often considered a first-line option.
- Tricyclic antidepressants — at low doses, this class can reduce migraine frequency independent of any effect on mood. It may be particularly relevant where migraine coexists with tension-type headache or sleep difficulties.
- Anti-seizure (anticonvulsant) medications — originally developed for epilepsy, certain agents in this class have shown benefit in migraine prevention. Specific side-effect profiles and pregnancy-related contraindications apply, particularly in women of childbearing age.
- Angiotensin receptor blockers (ARBs) — a cardiovascular medication class with emerging evidence as a preventive option for some patients.
- Monoclonal antibody preventives — a newer specialist-prescribed class for chronic migraine that has not responded to other preventives. These target specific migraine-related pathways. Eligibility criteria apply, typically requiring neurologist review.
- Specialist-administered injection therapies — certain injection-based preventive options are available for chronic migraine in patients who meet specific eligibility criteria, administered by a specialist.
All preventive medications take time to reach their full effect — usually six to eight weeks at an adequate dose. A GP will generally recommend a trial of at least two to three months before assessing whether it is working. Dose adjustments are common, and finding the right preventive may involve a careful, guided process with regular review.
Australia's Therapeutic Goods Administration (TGA) requires prescription medicines to be used only under a registered doctor's supervision. This article does not name or recommend specific medicines. Selection, dose, and duration are clinical decisions made at the point of consultation.
Lifestyle and behavioural approaches
Alongside medication, several lifestyle strategies may help reduce migraine frequency:
- Regular sleep — a consistent sleep schedule, even on weekends, can reduce attack frequency.
- Hydration and regular meals — skipping meals and dehydration are common, avoidable triggers.
- Stress management — mindfulness, progressive muscle relaxation, and cognitive behavioural therapy (CBT) have been studied as adjuncts. Headache Australia highlights the role of psychological approaches in comprehensive care.
- Physical activity — moderate, consistent exercise is associated with reduced migraine frequency in some studies. High-intensity or irregular exercise can be a trigger for some individuals; build up gradually with GP input.
- Hormonal triggers — for women whose attacks cluster around menstruation or perimenopause, a GP can discuss strategies including timing of preventive therapy or, where appropriate, a broader hormonal assessment.
Specialist referral
If migraine does not respond to preventive therapies trialled in general practice, or if specific red flags are present, a GP can arrange referral to a neurologist or headache specialist. Some specialist-only therapies for chronic migraine are only accessed through this pathway, and specific eligibility criteria apply.
Not every headache requires a doctor's visit, but there are clear situations where a medical consultation is important. The following are signs that it is time to speak with a GP about migraine:
- Headaches are becoming more frequent or more severe — A change in the pattern of headaches, particularly an increase in frequency, is worth investigating.
- Over-the-counter medication is no longer effective — If simple analgesics are not providing adequate relief, a GP can explore prescription options that may be more suitable.
- Headaches are affecting daily life — Missing work, cancelling plans, or spending days in bed due to headache pain is a signal that current management is not adequate.
- Medication is being used more than 10 to 15 days per month — This is a threshold for medication overuse headache, described by Headache Australia, and warrants a clinical review.
- New or unusual symptoms — Any new neurological symptoms, such as sudden onset of severe headache, weakness on one side of the body, confusion, visual loss, or difficulty speaking, should be assessed urgently. These may indicate a condition other than migraine.
- First migraine with aura — If aura symptoms have never occurred before, it is important to have them assessed by a doctor to rule out other neurological causes.
- Migraine and hormonal contraception — Migraine with aura has specific implications for the safety of certain types of hormonal contraception. A GP can advise on the most appropriate options, as outlined in Healthdirect Australia's guidance.
It is also worth seeing a doctor simply to get a diagnosis. Many people with migraine have never had the condition formally identified. A diagnosis opens the door to targeted treatments that would not otherwise be considered.
Migraines disrupting your life?
Migraine is a condition that is well-suited to management through online GP consultations. The diagnosis is primarily clinical, meaning it is based on a detailed history of symptoms rather than physical examination or imaging in most cases. A GP can assess the pattern of headaches, identify triggers, discuss treatment options, prescribe medication where clinically appropriate, and build a long-term management plan, all through a video consultation. For a general overview of when video care is suitable, see our guide on telehealth vs in-person GP consultations.
For patients in regional and remote Australia, where access to a GP may involve long travel times and extended waiting periods, online consultations remove a significant barrier. For working professionals and parents who cannot easily take hours out of their day for a clinic visit, the ability to see a GP from home or from work during a break makes it more likely that treatment will actually happen rather than being deferred indefinitely.
Online consultations are also well-suited to the ongoing nature of migraine management. Migraine is not typically a one-appointment condition. Effective treatment often involves follow-up consultations to assess whether a medication is working, adjust doses, try a different approach, or revisit the management plan as circumstances change. Continuity of care — seeing the same GP across multiple visits — makes this process more efficient and more personalised. The clinician builds an understanding of the patient's specific migraine pattern, what has been tried, what has worked, and what has not.
If a GP determines during a consultation that a referral to a neurologist or headache specialist is warranted, they can arrange that referral and provide the supporting documentation. If a prescription is clinically appropriate, it can be issued as an electronic prescription and sent directly to the patient's preferred pharmacy. For more on how this works, see our explainer on online pharmacies and escripts in Australia.
Abby Health is one of Australia's largest online-first clinics, built on the principle that long-term, continuous GP care should be accessible to every Australian — not just those who live near a well-staffed clinic with short wait times.
Our care network includes more than 300 clinicians available seven days a week, 365 days a year (Abby Health internal data, Q1 2026). All Abby Health practitioners hold current AHPRA registration. Consultations are bulk billed for eligible patients with a valid Medicare card. Strict eligibility criteria apply. Scheduled and First Available queues give patients flexibility depending on urgency.
Continuity matters for a condition like migraine, where treatment is refined over time. Seventy-one per cent of Abby patients who rebook see the same doctor again (Abby Health internal data, Q1 2026). For many patients, the clinician reviewing this month's medication trial is the same one who first assessed the headache pattern — already familiar with triggers, previous trials, and what has worked.
This continuity is supported by Abby AI, our medical AI, which surfaces prior headache episodes, prescription history, allergy information, and relevant chronic conditions before the clinician begins the appointment. Abby AI never diagnoses and never prescribes. It is a decision-support tool that helps the clinician start informed. For migraine, where the history is the diagnosis, that context matters.
Clinical governance is led by Dr Bosco Wu, our Clinical Director and a sitting member of the AMA NSW Council. Our Chief Medical Officer, Dr Ramu Nachiappan, brings 35 years of general practice experience, including decades serving Broken Hill. Prescribing protocols for migraine care — including medication-overuse prevention, red-flag escalation, and referral pathways to neurology — are built into the clinical framework our team operates within.
If a prescription is clinically appropriate, it can be issued during the consultation and sent electronically to the patient's preferred pharmacy. If a referral to a neurologist or headache specialist is warranted, the GP can arrange that as part of the appointment.
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