How to talk to your doctor about migraines

Short answer: clinicians have 15 minutes (often less). The visits that change care are the ones where you walk in with structured data rather than recall — frequency, severity, treatment history, what worked, what didn’t. This page covers what clinicians actually look at, the format that lands well, and how to use Hermly’s doctor report.

What clinicians want to see — in priority order

In conversations with headache specialists and migraine researchers, the same priority list comes up repeatedly:

1. Frequency, in days per month

The single most important number. Specifically:

• Headache days per month (any headache, all causes).
• Migraine days per month (attacks meeting your usual pattern).
• Trend over the last 3+ months — is it stable, rising, or falling?

This number determines treatment decisions. The threshold for recommending preventive medication is usually around 4–6 migraine days/month. The threshold for chronic migraine diagnosis is 15+ headache days/month. The threshold for Botox coverage is 15+. Frequency is the gateway.

2. Severity distribution

Not just “they’re bad” but:

• Typical attack pain (0–10).
• Worst attack in the last 3 months.
• How many attacks reach the disabling threshold (you can’t function normally).

The MIDAS score formalises this — it’s a 5-question disability assessment that takes 90 seconds and produces a number clinicians read instantly.

3. Current treatment + response

• What acute medication you use, how many days per month, and how well it works.
• What preventive medication (if any), how long, and effect.
• What you’ve tried in the past and stopped — why you stopped is as important as the fact that you did.

4. Triggers and pattern

• What you’ve noticed about your own triggers — knowing the patient’s beliefs is important even when the cohort evidence is mixed.
• Predictable windows — menstrual, weather, stress.
• Recent life changes that might shift the pattern.

5. Goals and constraints

• What “better” would look like to you. Half the attacks? No disabling attacks? Better acute relief? These imply different treatments.
• Constraints — pregnancy planning, occupation (drowsiness medications might not work), cost, insurance.

The format that lands well

A clinician reading your data in the 60 seconds before they walk in will appreciate:

• A calendar showing attack dates — visual pattern shows up immediately.
• One paragraph summary — 4 sentences max.
• Frequency + medication tables — numbers in a table beats prose every time.
• Trigger pattern in plain English — “Across 8 attacks this quarter, 5 occurred on perimenstrual days” beats “I think my period might be a trigger”.

What doesn’t land well:

• 90 pages of free-text journal entries.
• Daily mood scores when there’s no headache context.
• Self-diagnosis of specific subtypes or causes.
• Print-outs of generic migraine information they already know.

Using Hermly’s Doctor Report

Hermly generates a structured PDF specifically designed for this purpose. The format covers:

• Header: patient name (optional), report period, “Self-reported, not medically diagnosed” stamp.
• Plain English summary: 4 sentences synthesising the 3-month period.
• Attack calendar: visual grid of headache and migraine days.
• Frequency table: monthly attack counts, average pain intensity, average duration.
• Medication table: acute meds taken, days per month, MOH threshold check.
• Trigger correlations: per-factor association across the period.
• Topics worth discussing: 3–5 items that the data surfaces for clinical attention (never “recommendations” — Hermly doesn’t prescribe).

The report is generated on-device, sent only when you choose (email, AirDrop, Files app), and is not the same thing as sharing your raw Hermly data. The clinician gets the summary, not your daily logs.

Specific questions worth raising

These come up in patient-clinician research as productive questions:

• “I’m averaging X headache days per month. Are you comfortable with that, or should we look at prevention?”
• “I’ve tried [medication]. It [didn’t work / worked but had X side effect]. What’s the next reasonable step?”
• “Is there a specific reason you’re recommending [medication] over the alternatives?”
• “What’s the realistic timeline before we know if this is working?”
• “What would make you refer me to a headache specialist?”
• “I’ve noticed [pattern]. Does that change what we should try?”

Avoid these (they’re well-meaning but often unproductive):

• “Can you just give me [specific drug]?” without context.
• “I read on a forum that [X]” without indicating what you want from the conversation.
• “Will this ever go away?” — most clinicians don’t know, and the honest answer doesn’t help your treatment plan.

When to seek a headache specialist

Primary care can manage most cases. Refer-to-specialist triggers include:

• Frequent attacks (4+ migraine days/month for 3+ months).
• Failed adequate trials of 2+ preventive medications.
• Chronic migraine (15+ headache days/month).
• Severe attacks requiring ED visits.
• New or changing patterns in someone over 50.
• You want access to CGRP medications, Botox, or other advanced treatments that some primary care clinicians don’t prescribe routinely.

A UCNS-certified (United Council for Neurologic Subspecialties) headache specialist has done a 1–2 year fellowship after neurology residency specifically in headache disorders. The list is at ucns.org.

What this isn’t

Not a script for the visit — every patient-clinician relationship finds its own rhythm. Not a list of demands — visits work best as collaboration. Not a substitute for direct conversation when something is going wrong.

What it is: a checklist for the night before a visit, so the 15 minutes are spent on what matters rather than reconstructing 3 months from memory.