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Migrane Questions

You and your symptoms

Are you over the age of 18 - 65?


Did a GP or neurologist diagnose your migraine?


Have you had more than 10 migraines in a month?


Do your migraines last less than 4 hours without treatment or last longer than 24 hours?


Do your migraines follow a broadly similar pattern each time?


When you have a migraine do you get any of the following symptoms?


  • Weakness of one of the body
  • Double vision
  • Loss of vision in one or both eyes
  • Ringing/ buzzing noise in your ears
  • Hearing loss
  • Slurred speech
  • Clumsiness
  • Loss of balance confusion

Have you taken a ‘triptan’ medication in the past and within the first few hours of taking it have you experienced sensations such as heaviness, pressure or tightness in the body (especially chest or throat, palpitations, flushing, dizziness, rash, a


Have you ever had any of the following conditions?


  • High Blood pressure
  • Angina
  • Heart attack
  • Adnormal heart rhythm
  • Heart disease of any kind
  • Stroke or a mini stoke
  • Peripheral vascular disease
  • Epilepsy or seizures
  • Ever liver or kidney disease

Do you or have you suffered from any heart problems stroke, angina or any other heart related problems ?


Are you taking any medication that has been prescribed by your Gp/Doctor or Hospital ?


Do you give consent for us to contact you GP if required? (we need this to process any order for medication)


Current Health

Are you taking any of the following medications?


  • The migraine medications Ergotamine or Methysergide
  • Any other ‘triptan’ migraine medication taken within last 24 hours (e.g. naratriptan,rizatriptan, zolmitriptan, almotriptan or eletriptan (NOTE: we advise different types of ‘triptans’ should not be taken within 24 hours of one another)
  • MAOIs (monoamine oxidase inhibitors) or if you have taken an MAOI in the last 2 weeks (e.g. Mocobemide, Phenelzine, Isocarboxazid and Tranylcypromine)
  • SSRIs, usually used to treat depression (Selective Serotonin Reuptake Inhibitors – e.g. Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline and Priligy)
  • SNRIs used to treat depression (Serotonin Noradrenaline Reuptake Inhibitors e.g. Duloxetine, Dapoxetine, Venlafaxine and Mirtazapine)
  • Reboxetine, Tryptophan or Flupentixol
  • Lithium
  • Selegiline
  • St John’s Wort (Hypericum perforatum)
  • Cimetidine (for indigestion or stomach ulcers)
  • Propranolol (beta-blocker)
  • Any current antibiotics (antibiotic course needs to be completed at least 72 hours before taking a triptan)
  • Antifungals (e.g. Ketoconazole, Itraconazole)
  • The combined oral contraceptive pill (not the progesterone only mini pill)

Do you need the morning after pill for the following reasons?


  • I recently engaged in unprotected sexual intercourse (24 hours)
Agreement

Do you agree to the following statements?


  • You must read the patient information leaflet supplied with your medication
  • You must contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use only.
  • You have answered all the questions in this short medical assessment accurately and truthfully to the best of your knowledge. You understand our doctor take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
all of our tests and treatments are price competative

You need to complete our short medical questionnaire so we can ensure the treatment you have selected is safe for you to use

all of our tests and treatments are price competative

Need Help?

If you need help with this medical questionnnaire call us on 07549286701

 
quality products assured across youth revisited

Quality products

all of our tests and treatments are price competative

Affordable prices

all of our pharmacies and and treatments purchased are from well known and trusted UK pharmacies

UK pharmacy

all of our tests and any other products purchased will be dispatched for a next day service

Express next day delivery

If you have any further questions about any of our products please feel free to contact us and we will do our best to help you.
Once you have your prescription we will be able to process your order through our trusted UK Pharmacy.