Headache Centre · Turin
First headache and migraine consultation
How to prepare, what to describe and which questions to ask. Your care pathway begins with your story.
To print or keep on your phone
Your first-consultation checklist
A two-page A4 PONOS infographic, available in Italian, to keep and bring to your appointment.
- Documents, medication, diary and questions: what to prepare.
- Changes in your headache to describe during the consultation.
- Appointment details, addresses of all three locations, parking and practical directions.
- Space to note your goals and questions.
Before your appointment
Four things to prepare
Documents, treatments, a diary and your goals help reconstruct the clinical picture and make time for the questions that matter.
Your medical records
Bring all previous medical records: neurological consultations, MRI/CT scans, dental or cervical reports and discharge letters, even if they do not seem directly related to your headache.
Medicines already tried
Prepare a list giving, where possible, dose, duration, benefit, adverse effects and the reason for stopping. Include both acute and preventive treatments.
Your headache diary
If available, bring a diary recording headache days, attack duration, intensity, associated symptoms and medication taken. How often you take medication is also useful information.
Questions and goals
Write down your main questions and what you hope to achieve: fewer headache days, lower intensity, less medication or a return to a particular activity.
Medication before your consultation: do not stop or change it on your own, unless your treating doctor has already instructed you to do so.
Has your headache changed? Describe changes over recent months or years: location, side, frequency, duration, nausea, autonomic symptoms and the development of neck, occipital, jaw or facial pain.
The clinical pathway
From the history of your pain to treatment decisions
The first consultation aims above all to understand whether your migraine has changed or another pain component has developed. This distinction determines the next steps.
Listen
Reconstruct symptoms, changes, treatments and their effects on daily life.
Assess
Bring together your account, medical records and clinical assessment.
Distinguish
Consider the type of headache and possible associated pain components.
Share decisions
Define goals, alternatives and the purpose of any further investigations.
Information that guides decisions
Clinical questions at the first consultation
Pain intensity is only part of the picture. Timing, location, associated symptoms and what has changed also matter.
Frequency, duration and location
- How many days each month do you have a headache, and how many have migraine-like features?
- How long does each attack last? Is the pain always on the same side or does it change?
- Have the location, frequency, duration or associated symptoms changed compared with previous years?
Symptoms during an attack
- Do you experience nausea, photophobia, phonophobia, aura or worsening with physical activity?
- Do you have tearing, nasal congestion, a runny nose, eye redness, ptosis or restlessness?
Neck, jaw and face
- Has there been new or increased neck or occipital pain? Does it change with posture, neck movements or local pressure?
- Do you have bruxism, TMJ pain or pain when chewing?
- Did implants, extractions, dental injuries or new facial pain precede the change in your headache?
Treatments and your personal circumstances
- Which medicines do you use for attacks, and how often?
- Which preventive treatments have you tried, including CGRP-targeted treatments or botulinum toxin?
- Are there circumstances that change the balance of benefit and risk, such as planning a pregnancy, intolerance or other medicines you take?
A targeted assessment
What we aim to understand
Chronic or treatment-resistant migraine
Review of the diagnosis, acute and preventive treatments, and the results actually achieved.
Cervical or occipital component
Assessment of the cervical spine, facet joints and occipital nerves.
TMJ pain, bruxism and trigeminal pain
Further assessment of temporomandibular, dental or neuropathic craniofacial components.
A different headache presentation
A change in pain characteristics requires a new differential diagnosis, including consideration of trigeminal autonomic cephalalgias.
Interventional pain management
When a procedure makes sense
A procedure is not proposed automatically after medication fails. It becomes part of care when there is a plausible, verifiable peripheral target and a diagnostic test can answer a specific clinical question.
A block or injection is more than a treatment: in some cases, its main purpose is to establish whether that structure truly contributes to the pain and how to interpret any benefit, even if temporary.
On the usefulness of a headache diary: NICE CG150, headache assessment and diagnosis.
The next step
Arrange your first consultation
For appointment information and practical or clinical questions after your consultation, use the PONOS Clinic contact details.