Ten minutes with your GP: making a headache appointment count

You have ten minutes. You have years of headaches, a handful of medications you half remember trying, and a strong suspicion that you will be out of the door with a prescription and no real answer. That suspicion is often fair. It is also fixable, at least in part. Here is how to walk in prepared, and what a good headache consultation should give you back.

The clock is not your fault

The standard GP appointment in the UK is ten minutes. The Royal College of GPs itself has called for fifteen minutes as the norm, because so many patients arrive with more than one problem and a history that takes time to hear. Headache is the textbook example. There is no scan or blood test that names a migraine. The diagnosis lives almost entirely in your story, and a story told in a rush comes out in fragments.

So if previous appointments have ended with "headache" and a shrug, that is a system problem before it is a you problem. The good news is that a small amount of preparation does a surprising amount of the work.

Three numbers that do most of the work

Dr David Kernick, a GP who runs a specialist headache clinic in Exeter, makes the point that GPs do not need a wall of data. A simple summary is enough. In practice, three numbers carry more weight than any diary app export.

• Headache days a month. Not attacks, days. Fifteen or more headache days a month, with at least eight of them having migraine features, is the threshold for chronic migraine, and that label opens different treatment pathways from episodic migraine.
• Medication days a month. How many days you took anything for the pain. Triptans on ten or more days, or paracetamol, aspirin or anti-inflammatories on fifteen or more, for three months or longer, raises the possibility of medication overuse headache. Up to seven in ten people with chronic migraine have it, and it is treatable once it is named.
• Period days. If you menstruate, mark the days you bleed. A pattern across two or three cycles is worth far more than a hunch that "it might be hormonal".

NICE recommends a diary of at least eight weeks to support the diagnosis. If you do not have eight weeks in hand, do not wait for a perfect record. Two or three weeks of honest ticks, plus a rough estimate for the months before, still beats reconstructing the year from memory under the clock.

Say the impact out loud

Clinicians are trained to ask about pain. They are less consistently trained to ask what the pain costs you, and a GP will only understand how disabling the condition is if you tell them. One sentence is enough. "I lost four working days last month" or "I cancel plans two weekends in three" lands differently from "they are pretty bad". The Migraine Trust puts this at the top of its advice for a reason.

Mention nausea and light sensitivity if you have them, even if they feel like footnotes. Any severe headache that comes with nausea, or gets worse with light, sound or movement, is very likely to be migraine. Those details are the diagnosis, not the decoration.

What you should come away with

A working name for what is going on, in plain language. A plan for the attacks themselves, which may include a migraine-specific treatment rather than another round of general painkillers. If a first triptan did not help, that is not the end of the family. A check on whether your painkiller days are part of the problem. And if attacks are frequent, a conversation about prevention.

You are also entitled to ask for a referral. The Migraine Trust lists three reasonable grounds: doubt about the diagnosis, attacks that are getting worse, and no response to what the GP has been able to prescribe. If one of those applies to you, saying so is not being difficult. It is being accurate.

If the appointment still does not land

Sometimes you do everything above and still leave with a placeholder. That is where a longer, headache-focused assessment earns its keep. In this clinic a first appointment is built around the story, the pattern and the rest of you: neck and jaw, sleep, mood, hormones and medication use. The aim is the same as your GP's, a defensible name and a plan, with the time to reach it. And when the picture points to something a GP or neurologist needs to prescribe, part of the job is writing that up clearly so the next ten minutes are spent on treatment, not on starting again.

If you would like your headaches assessed with the time they deserve, or help preparing for a GP or neurology appointment, you are welcome to book an appointment or get in touch.

• The Migraine Trust. Kernick D. What to expect during GP appointments for migraine, and how to get the most out of them (parts one and two), 2024. migrainetrust.org
• The Migraine Trust. Visiting your GP. migrainetrust.org
• National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management (CG150). nice.org.uk
• Royal College of General Practitioners. GPs need more time with patients, 2023. rcgp.org.uk
• International Classification of Headache Disorders, 3rd edition (ICHD-3). ichd-3.org

This article is general information, not a diagnosis or a substitute for individual medical advice.