Adult Migraine Treatment and Medication Refills (Migraine)
Fast MD-only migraine care and medication refills by secure online video visit, $49 flat-fee, no insurance required.
Migraine is a recurrent headache disorder that can cause moderate to severe head pain, nausea, and sensitivity to light or sound. TeleDirectMD focuses on safe, guideline-based refills for established migraine diagnoses, triptan continuation when appropriate, and clear instructions on when in-person or emergency evaluation is required for new or changing headaches.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Online MD-Only Migraine Refills
- Refills for established migraine diagnosed previously by a clinician
- Continuation of appropriate triptan therapy when safe
- Review of current regimen, triggers, and red-flag symptoms
- Clear criteria for when imaging, neurology, or ER care is needed
Adults 18+ only. TeleDirectMD does not prescribe opioids, butalbital combinations, carisoprodol, or benzodiazepines for headache and does not manage first or “worst-ever” headaches by telehealth.
What Is Migraine in Adults?
Migraine is a primary headache disorder characterized by recurrent attacks of head pain that are often throbbing, moderate to severe in intensity, and worsened by routine physical activity. Many adults also experience nausea, vomiting, and sensitivity to light, sound, or smells. Attacks may last 4–72 hours if untreated.
Some adults have migraine with aura, where neurologic symptoms such as visual changes, tingling, or speech disturbance occur before or during the headache. Others have migraine without aura. Once a diagnosis has been established, telehealth can often support ongoing care and medication refills, as long as there are no new red-flag features such as sudden onset, neurologic deficits, or major changes in pattern.
Symptoms and Red Flags in Adult Migraine
Many adults with a known history of migraine can be safely managed via telehealth when the pattern is stable. Certain symptoms, however, suggest a secondary cause of headache or other emergency that requires in-person or emergency evaluation instead of a virtual refill visit.
| Symptom | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Recurrent one-sided throbbing headache with nausea and light sensitivity | Typical migraine pattern in a known patient | Yes, often appropriate for telehealth refills if stable | Not a red flag alone if pattern and features are unchanged |
| Predictable migraine triggered by stress, hormones, or certain foods | Established migraine with identifiable triggers | Yes, if no new neurologic symptoms or major change in course | Change to daily or progressively worsening headaches |
| Visual aura such as zigzag lines or blind spots followed by headache | Possible migraine with aura in a known patient | Telehealth may be appropriate for ongoing care if prior workup completed | First-ever aura, prolonged aura, or new neurologic deficits |
| “Thunderclap” headache reaching maximal intensity in seconds | Possible subarachnoid hemorrhage or other emergency | No | Requires immediate emergency department evaluation |
| Headache with fever, neck stiffness, or confusion | Possible meningitis or serious infection | No | Urgent in-person or emergency evaluation is required |
| Headache with new weakness, trouble speaking, or facial droop | Possible stroke, transient ischemic attack, or other neurologic emergency | No | Requires emergency evaluation, not telehealth |
| New or different headache in a patient older than 50 years | Possible secondary headache (e.g., temporal arteritis, mass) | Telehealth may help triage but not definitively manage | Needs timely in-person assessment and possible imaging or labs |
| Daily use of acute medications with worsening headache | Medication overuse headache complicating migraine | Telehealth can identify the pattern and give guidance | Severe deterioration, systemic symptoms, or neurologic deficits |
| Headache after significant head trauma or fall | Possible intracranial bleed or other injury | No | Needs urgent in-person or emergency evaluation |
Differential Diagnosis: Migraine vs Other Adult Headaches
Not every headache is migraine. During your TeleDirectMD visit, the MD will review the onset, quality, associated symptoms, and prior workup to distinguish migraine from other headache types and from dangerous secondary causes.
Migraine (Typical Pattern)
- Moderate to severe, often one-sided, throbbing or pulsating pain
- Worsened by routine activity, with nausea and light or sound sensitivity
- Attacks last 4–72 hours if untreated, with symptom-free intervals
- Responds to migraine-specific medications such as triptans when used early
Other Headache Types and Causes
- Tension-type headache: Band-like, pressing pain on both sides, often milder and without nausea.
- Cluster headache: Severe, one-sided pain around the eye with tearing, redness, and restlessness in short, repeated attacks.
- Medication overuse headache: Near-daily headache in the setting of frequent pain reliever use.
- Secondary headache: Headache from infection, bleeding, mass, high pressure, or other systemic illness that requires in-person evaluation.
Telehealth is best suited for adults with a prior migraine diagnosis and a stable pattern who need safe medication refills or adjustments. New, severe, or evolving headaches often require in-person assessment, imaging, or specialty follow-up.
When Is a Video Visit Appropriate for Migraine Refills?
When a Video Visit Is Appropriate
- Adult 18+ with an established migraine diagnosis from a prior clinician
- Stable migraine pattern without new neurologic symptoms
- Needs refill of a previously prescribed triptan or migraine regimen
- Headache frequency and severity are not rapidly worsening
- No history of complicated migraine with recent concerning changes
- No recent head trauma, fever, or signs of infection
- Patient can describe prior imaging or evaluation, if done
Red Flags Requiring In-Person or ER Care
- First or “worst-ever” severe headache
- Thunderclap onset reaching peak intensity within seconds
- Headache with fever, neck stiffness, confusion, or seizure
- Headache with new weakness, trouble speaking, or vision loss
- Headache after significant head trauma or fall
- New daily or rapidly progressive headaches, especially in older adults
- Pregnancy-associated headaches with concerning features
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD is not an emergency service and does not manage new or life-threatening headaches by telehealth.
Treatment Options and Refill Approach for Adult Migraine
For adults with a confirmed migraine diagnosis, treatment focuses on early, effective acute therapy at the start of an attack and on avoiding medication overuse. TeleDirectMD prioritizes evidence-based use of migraine-specific agents such as triptans and supportive medications, while avoiding high-risk or habit-forming drugs.
Supportive Measures and Lifestyle Strategies
- Identify and limit common triggers such as missed meals, dehydration, sleep loss, or specific foods.
- Maintain regular sleep, hydration, and exercise patterns when possible.
- Use a headache diary to track frequency, triggers, and response to medication.
- Limit use of acute medications to avoid medication overuse headache.
Medication Refills and Adjustments (When Appropriate)
- Continuation of a previously effective triptan regimen when safe and without contraindications.
- Use of nonsteroidal anti-inflammatory drugs such as naproxen as part of an acute plan.
- Short-term use of antiemetics such as ondansetron to help with nausea during attacks.
- Discussion of preventive strategies and coordination back to primary care or neurology when needed.
TeleDirectMD does not prescribe opioids, butalbital-containing products, carisoprodol, or benzodiazepines for headache. New long-term preventive regimens and complex cases often require ongoing in-person primary care or neurology follow-up rather than telehealth-only management.
Common Medications Used for Adult Migraine (Refills)
The exact medications and dosing are individualized based on your migraine pattern, cardiovascular risk factors, prior responses, and other conditions. The table below shows typical examples your MD may consider when refilling or adjusting therapy for an established migraine diagnosis.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Sumatriptan 50–100 mg tablet | 50–100 mg by mouth at migraine onset; may repeat once after 2 hours if needed | Acute use only; limit to recommended maximum tablets per month | First-line triptan in many adults with established migraine and no contraindications |
| Rizatriptan 10 mg tablet | 10 mg at onset; may repeat once after 2 hours if needed | Acute use only; limit days of use per month | Alternative triptan for adults who respond better or prefer this agent |
| Naproxen 500 mg tablet | 500 mg by mouth at onset, with food | Acute use; do not exceed recommended daily or weekly limits | Adjunct for migraine attacks, often combined with a triptan when appropriate |
| Ondansetron 4–8 mg tablet or ODT | 4–8 mg by mouth or ODT every 8 hours as needed for nausea | Short-term use during migraine attacks | Adults with significant nausea or vomiting during migraine without contraindications |
These are example regimens only. Actual medications, strengths, quantities, and refills are determined by the MD after reviewing your history, cardiovascular risk factors, other diagnoses, and current medication list. TeleDirectMD does not prescribe opioids, butalbital-containing products, carisoprodol, or benzodiazepines for migraine.
Home Care, Expectations, and Return to Work
Migraine is a chronic condition that often improves but does not completely disappear. The goal of treatment is to reduce attack frequency, shorten duration, and improve function at home and at work.
- Use acute medications as directed and as early as possible in an attack.
- Avoid using acute medications on more than the recommended number of days per month.
- Maintain regular sleep, hydration, and meals to reduce trigger accumulation.
- Track headaches and share patterns with your MD to fine-tune the plan.
- Seek in-person care if headaches change abruptly, become daily, or are associated with red-flag symptoms.
Many adults with migraine can continue working with a well-designed acute treatment plan. If a work note is needed, TeleDirectMD can generally provide documentation of evaluation and treatment rather than long periods off work, unless additional medical issues are present.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care for adults using secure video visits to evaluate conditions like migraine. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, clarify what can be safely managed via telehealth, and explain when in-person primary care, neurology, imaging, or emergency evaluation is more appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.
Adult Migraine Refill FAQs
Telehealth refills are best suited for adults who already have a migraine diagnosis from a clinician, have a stable pattern of attacks, and are using medications such as triptans without major side effects. If your headaches are new, rapidly worsening, or very different from your usual pattern, you should be seen in person instead of relying on a virtual refill visit.
TeleDirectMD focuses on refills and continuation of care for adults with an existing migraine diagnosis. While we can review your history and prior evaluations, new or first-time severe headaches often require in-person assessment and sometimes imaging. In those situations, we will advise you to seek local care rather than start a full migraine workup solely by telehealth.
Depending on your history and risk factors, we may be able to refill triptans such as sumatriptan or rizatriptan, nonsteroidal anti-inflammatory drugs like naproxen, and supportive medications such as ondansetron for nausea. We do not prescribe opioids, butalbital-containing products, carisoprodol, or benzodiazepines for headache through TeleDirectMD.
Long-term preventive migraine therapy, such as daily oral preventives or injectable biologics, is usually best managed by your primary care clinician or a neurologist who can follow you over time. TeleDirectMD can discuss preventive strategies and help with short-term bridge refills in selected cases, but ongoing preventive management is typically not done exclusively by telehealth refills.
Many guidelines suggest limiting triptan use to a maximum number of days per month to reduce the risk of medication overuse headache. During your visit, the MD will ask how often you use acute medications and will help you stay within safe limits. If you need frequent triptan use, you may benefit from preventive strategies and in-person follow-up rather than relying on repeated acute dosing alone.
Red flags include a sudden thunderclap headache that reaches maximum intensity within seconds, headache with fever and neck stiffness, headache with new weakness, trouble speaking, or vision loss, a severe headache after head trauma, or headaches that are rapidly worsening in pattern. In these situations, emergency evaluation is safer than a telehealth refill visit.
Many adults with classic migraine do not need repeat imaging once a diagnosis is secure and there are no new red-flag features. However, if you have never been evaluated for severe or atypical headaches, or if your pattern has changed significantly, in-person assessment and possible imaging may be recommended before continuing long-term refills. We will review your history and advise you case by case.
Frequent use of pain relievers or triptans can lead to medication overuse headache, where the medications themselves keep the headache cycle going. We can help identify this pattern, give initial guidance, and suggest a safer plan, but many patients with medication overuse headache benefit from coordinated in-person care and structured tapering rather than repeated telehealth refills alone.
Migraine can be very painful and disabling, but most migraine attacks in otherwise healthy adults are not a sign of brain damage or stroke. The main concern is to rule out secondary causes when the pattern is new or changing and to treat attacks effectively while avoiding medication overuse. Your TeleDirectMD physician will review your history to ensure that refills are appropriate and safe for you.
TeleDirectMD offers MD-only, guideline-based migraine care and medication refills through secure video visits with a transparent $49 flat-fee model and no insurance required in 25+ states. We emphasize safe triptan use, avoidance of high-risk medications, clear red-flag education, and written guidance on when in-person neurology, primary care, or emergency evaluation is a better choice than telehealth alone.