Neurologist for Migraines: What to Expect

If you’ve ever had a migraine, you already know it’s not “just a headache.” It’s more like your brain decided to throw a surprise ravecomplete with strobe lights (hello, light sensitivity), booming bass (sound sensitivity), and a strict no-fun policy (nausea, dizziness, fogginess). If migraines are showing up often, hitting harder, or ignoring your usual fixes, seeing a neurologist for migraines (or a headache specialist) can be a turning point.

This guide walks you through what happens before, during, and after a neurology appointmentso you can feel prepared, ask smarter questions, and leave with a real plan (not just “try to relax,” which is adorable advice from someone who doesn’t have a migraine).

Why See a Neurologist for Migraines?

Many people manage migraine with primary care, urgent care, or a general clinicianespecially when attacks are occasional. A neurologist steps in when migraines become more frequent, more complicated, or more stubborn.

Common reasons you may be referred

• Frequent headache days (for example, 4+ headache days a month or attacks that disrupt school/work regularly)
• Worsening pattern (more severe, longer, or more frequent than before)
• New or unusual symptoms (especially new neurologic symptoms)
• Failed treatments (you’ve tried typical options and you’re still getting knocked out)
• Concern for another condition that needs evaluation
• Chronic migraine (headache on 15+ days/month with migraine features on some days)

Neurologists are trained to evaluate the nervous system, confirm whether your symptoms fit migraine (and which type), and build a treatment plan that includes both acute migraine treatment and preventive migraine medication when appropriate.

How to Prepare for Your Migraine Neurology Appointment

The fastest way to help a neurologist help you: show up with data. Not a 47-tab spreadsheet (unless that sparks joy), but a clear picture of your migraine pattern.

1) Keep a headache diary (even 2–4 weeks helps)

A headache diary is basically a migraine detective notebook. Bring notes from an app or paper log that includes:

• Date/time the attack started and ended
• Pain location and type (throbbing, pressure, stabbing)
• Severity (0–10) and impact (missed school/work? couldn’t drive?)
• Associated symptoms (nausea, vomiting, light/sound sensitivity, dizziness)
• Aura symptoms (visual changes, tingling, speech changes) and how long they lasted
• Possible triggers (sleep changes, stress, skipped meals, weather shifts, certain foods, hormones)
• What you took and when (meds, caffeine, hydration, rest) and whether it helped

2) Bring a medication and supplement list

Include:

• All prescription meds (even ones not “for migraine”)
• Over-the-counter meds (ibuprofen, acetaminophen, naproxen, cold meds)
• Supplements (magnesium, riboflavin, herbal products)
• Caffeine habits (coffee/energy drinksyes, it counts)

Pro tip: If you’ve been taking pain relievers frequently, mention it. Overusing certain acute meds can worsen headache frequency over time (something neurologists watch for).

3) Gather your “migraine backstory”

• When migraines started (childhood? teen years? after an illness?)
• Family history of migraine
• Other medical conditions (asthma, depression/anxiety, sleep issues, high blood pressure)
• Past head/neck injuries
• Hormonal factors (menstrual-related migraine, birth control changes, pregnancy/postpartum history if relevant)
• Previous imaging (MRI/CT) and lab results, if you have them

4) Write down your top 5 questions

Brain fog is realespecially in a doctor’s office. Consider questions like:

• Do my symptoms fit migraine, or could it be another headache type?
• Is this episodic or chronic migraine?
• What acute medication should I useand when should I take it?
• Do I qualify for preventive treatment?
• How do we avoid medication overuse headaches?
• What should I do if an attack doesn’t stop?

What Happens During the Visit?

A migraine neurology visit usually has three big parts: history, exam, and plan. The goal is to confirm the diagnosis, rule out red flags, and create a strategy that fits your life.

Part 1: The migraine interview (aka “tell me everything”)

Your neurologist will ask detailed questions. Expect topics like:

• How often you have headache days per month
• How many are migraine days (throbbing + light sensitivity + nausea, etc.)
• How quickly pain escalates and how long attacks last
• Whether you get aura and what it looks like for you
• Sleep, hydration, meals, exercise, stress, screen time
• Menstrual/hormonal patterns (if applicable)
• What treatments you’ve tried and what happened

Specific example: If you say, “I get headaches a lot,” the neurologist will translate that into, “Do you mean 6 days a month or 26?” Your diary helps you answer with confidence instead of guessing.

Part 2: The neurological exam (quick but important)

Most migraine patients have a normal neurological exam. That’s good news. The neurologist may check:

• Eye movements and pupils
• Face strength and sensation
• Arm/leg strength, reflexes, coordination
• Balance and gait
• Neck range of motion and tenderness

This helps identify whether anything suggests a different diagnosis or the need for more testing.

Part 3: Do you need tests (MRI/CT/labs)? Often, no.

Migraine is primarily diagnosed from symptoms and examthere isn’t a single blood test or scan that “proves” migraine. Imaging may be considered if:

• Your symptoms are atypical for migraine
• There’s a new neurologic finding on exam
• You have a sudden, severe headache or a major change in pattern
• There are other warning signs your neurologist wants to rule out

If imaging is recommended, the neurologist should explain what they’re looking for (for example, ruling out structural causes) and why it’s appropriate for your situation.

Red Flags: When Migraine Symptoms Need Urgent Care

Most migraines are not dangerous, but some headache situations deserve immediate evaluation. Seek urgent care/emergency help if you have:

• A headache that reaches peak intensity suddenly (“thunderclap” headache)
• New weakness, numbness, confusion, or trouble speaking (especially if this is not typical for you)
• Fever, neck stiffness, or a severe headache with signs of infection
• Headache after a head injury
• A new headache pattern that is dramatically different from your usual

Even if you’ve had migraine for years, “different than usual” is worth taking seriously.

Building Your Migraine Treatment Plan

A strong plan usually includes two lanes:

• Acute treatment: what to do when a migraine starts
• Prevention: how to reduce frequency, severity, and disability over time

Acute migraine treatment options

Your neurologist may recommend one or more of these categories depending on your symptoms, medical history, and how often you have attacks:

• NSAIDs (like naproxen/ibuprofen) for mild to moderate attacks
• Triptans for moderate to severe migraine (often best when taken early in the attack)
• Gepants (CGRP receptor antagonists) as newer migraine-specific acute options for some patients
• Ditans (a migraine-specific option that can cause drowsiness; driving restrictions may apply)
• Antiemetics for nausea/vomiting, sometimes used as part of acute rescue

Timing matters: Many migraine meds work best when taken earlybefore pain and nausea fully ramp up. Your neurologist will help you define “early” for your personal pattern.

When prevention enters the chat

Preventive migraine treatment may be considered when attacks are frequent, disabling, or not responding well to acute meds. Some guidance considers prevention for people with around 4 or more headache days per month, especially if those days are highly disabling.

Preventive options your neurologist may discuss

• Traditional preventives used in migraine care (such as certain beta-blockers, antiseizure meds, or antidepressants)
• CGRP-targeted therapies:
  • CGRP monoclonal antibodies (injections/infusions) designed specifically to prevent migraine
  • Preventive gepants (oral CGRP-targeting meds used on a schedule)
• OnabotulinumtoxinA (Botox) for chronic migraine in appropriate patients
• Neuromodulation devices (noninvasive stimulation options) for select patients
• Behavioral and lifestyle strategies (sleep regularity, hydration, nutrition, stress skills, exercise pacing)

Specific example: If you have 18 headache days a month and frequent nausea, your neurologist may recommend a preventive approach plus an acute plan with both a migraine-specific medication and an anti-nausea rescue optionso you’re not stuck trying to swallow pills while your stomach is staging a protest.

What About Triggers and Lifestyle? Expect a “systems” conversation

Neurologists (especially headache specialists) often treat migraine like the complex brain disorder it is. That means they may ask about “patterns” and “thresholds”the idea that multiple stressors can stack until your brain flips into migraine mode.

Common areas you’ll likely review

• Sleep: too little, too much, or irregular sleep can all matter
• Meals/hydration: skipping meals can be a big one
• Caffeine: can help sometimes, backfire other times, and cause withdrawal headaches
• Stress and recovery time: both stress and the “letdown” after stress can trigger attacks
• Hormones: for many people, migraine is sensitive to menstrual cycles or contraceptive changes
• Environment: weather shifts, strong smells, lighting, screens

The goal is not to turn your life into a trigger-avoidance obstacle course. It’s to identify the biggest drivers and build a plan that’s realisticbecause “avoid stress” is not a plan, it’s a comedy sketch.

Insurance, Refills, and Follow-Ups: The Not-So-Fun Part

Some migraine treatmentsespecially newer CGRP-targeting options, Botox, or devicesmay require insurance prior authorization. Your neurologist’s office may:

• Document how many headache days you have per month
• Record previous medication trials (what you tried and why it didn’t work)
• Request proof of diagnosis and disability level

This is another reason a headache diary is gold: it can support coverage decisions and show whether treatment is working.

Typical follow-up timeline

You may follow up in 6–12 weeks after starting or changing a preventive medication (sometimes sooner if attacks are severe). Migraine prevention often requires adjusting dose, timing, or even switching approaches. The best plans are iterativelike software updates, but for your brain.

How to Get the Most Out of Your Visit

• Be specific: “3 migraine days a week” beats “a lot.”
• Describe disability: missed days, canceled plans, lying in the darkthis matters clinically.
• Share what you’ve tried (and what side effects you had).
• Ask for a written plan: what to take first, second, and when to escalate.
• Clarify safety: medication interactions, pregnancy considerations, driving warnings, and dosing limits.

Conclusion

Seeing a neurologist for migraines can feel intimidatinguntil you realize the appointment is basically a strategy session with someone trained to decode what your nervous system has been doing. Expect a detailed conversation, a quick neurological exam, and a treatment plan that covers both stopping attacks and preventing future ones. Bring a headache diary, bring your questions, and don’t downplay how migraine affects your life. The goal is not to “tough it out.” The goal is to get your days back.

Experiences: What It’s Really Like to See a Neurologist for Migraines (Patient-Style Stories)

People often want the unfiltered version of what a migraine neurology visit feels like. While everyone’s story is different, there are some common experiences patients describeespecially during the first few appointments. Below are realistic, “you’re not alone” scenarios that match what many migraine patients report in clinics.

Experience #1: “I didn’t realize how many headache days I had until I tracked them.”

A lot of patients walk in saying, “I get migraines sometimes,” and then they start a diary and discover it’s actually 10–18 headache days a month. Not because they were exaggeratingbecause migraine becomes your normal. You adapt. You cancel plans. You learn which fluorescent lights to avoid. You keep going (until you can’t).

One common “aha” moment is realizing the days between attacks aren’t always symptom-free. People often report lingering neck pain, sensitivity to light, or brain fog. A neurologist may explain that migraine can have phases, and what feels like “random weirdness” can actually be part of the pattern. That’s validatingand it changes treatment decisions.

Experience #2: “The questions were intense, but I finally felt taken seriously.”

First-time neurology visits can feel like an interview: duration, location, severity, triggers, aura, sleep, hydration, medications, family history, menstrual cycle, stress, caffeine… all of it. Some patients worry they’re being interrogated. Most later realize the neurologist is building a diagnostic map.

Patients often say it’s the first time someone asked about disability directly: “How many school/work days did you miss?” “How often do you have to lie down?” “How long does it take to feel normal again?” Those questions can feel emotional because they point to the real cost of migraine. But they also help unlock better treatment optionsespecially when insurance requires proof of impact.

Experience #3: “I expected an MRI. I didn’t get one. That was… confusing.”

Many people expect brain imaging as a routine step. When the neurologist says, “Based on your symptoms and normal exam, you likely don’t need imaging,” some patients feel relievedothers feel dismissed. What many eventually learn is that migraine is typically diagnosed clinically, and scans are saved for red flags or atypical cases.

A helpful way patients describe reframing it: “No MRI” can mean your story fits migraine clearly and your exam is reassuring. If you’re worried, it’s reasonable to ask, “What would make imaging necessary for me?” Good clinicians explain their reasoning and document it clearly.

Experience #4: “The first treatment didn’t work. The second helped. The third was the winner.”

One of the most common real-world experiences is that migraine treatment is not one-and-done. Preventive meds can take weeks to show benefit. Doses may need adjustment. Side effects can happen. Some options work brilliantly for one person and do nothing for another.

Patients often report feeling discouraged after the first preventive fails. Neurologists usually expect that possibility. The “win” is having a structured plan: what to try next, what the timeline is, and how you’ll measure success (for example: fewer migraine days, shorter attacks, less rescue medication, improved function).

Experience #5: “Having a rescue plan reduced my anxietyeven when I still got migraines.”

People underestimate how stressful it is to live with unpredictable attacks. Many patients say the biggest relief was leaving with a clear rescue plan: “Take X at the first sign. If symptoms escalate, add Y. If you can’t keep meds down, use Z. If you have these warning signs, seek urgent care.”

Even before migraine frequency improves, having a plan can reduce fear and improve day-to-day confidence. You’re not guessing anymore. You’re executing a playbook.

Bottom line: Seeing a neurologist for migraines is often the start of a process, not a single appointment miracle. But for many patients, it’s the first time migraine is treated like the real neurologic condition it iswith a diagnosis that makes sense and a plan that’s built to evolve.