Consultation

Are you under 18 or over 65?

Are you pregnant or breastfeeding?

Are you allergic to any of the following?
Any triptan medication including sumatriptan, naratriptan, rizatriptan, almotriptan, eletriptan, zolmitriptan, and frovatriptan.
Antibiotics called sulphonamides and are ordering sumatriptan (if you are not sure please check with your GP)

Have you been diagnosed with any of the following conditions caused by poor circulation?
Heart disease due to narrow arteries (angina, chest pain on exertion, or heart attack)
Cramp like pain in the legs when walking caused by poor circulation
Stroke or mini-stroke (TIA)
Irregular heart rhythms or changes on an ECG (electrocardiogram)

Do you have any problems with your liver or kidneys?

Have you been diagnosed with any of the following?
Uncontrolled high blood pressure (not including blood pressure controlled by medication)
Serious liver or kidney disease
Epilepsy or a tendency to seizures (fits)

Have you been diagnosed with high blood pressure?
If your blood pressure is controlled on medication answer ‘No’
If you do not know or have not had a blood pressure check in the last 2 years answer ‘Yes’

Do your migraines last less than 4 hours without treatment? Or do they last longer than 24 hours?

Are you taking any of the following medication?
Antidepressants known as MAOIs (these antidepressants are NOT often prescribed, however the possible interaction with triptans is important)
SSRI/SNRI/St John’s wort
Ergotamine or similar (rarely used prescription medicine for migraine)
Propranolol and are ordering rizatriptan or Maxalt (answer ‘No’ if ordering sumatriptan, Imigran, zolmitriptan, or Zomig only)

Are you aware chest pain or a feeling of pressure in the chest lasting more than a few minutes after taking triptans requires urgent medical attention?
This could be symptoms of a heart attack (this is extremely rare and very unlikely).

Do any of the following apply to you?
Your headaches started after the age of 40 and you have not seen your GP about them
Your headaches symptoms are getting worse or more frequent and you have not seen your GP
You have new headaches and other signs of being generally unwell, e.g. unintentional weight loss, neurological symptoms, eye symptoms – and you have not seen your GP

Are you aware that different triptan medication should not be used within 24 hours of each other or for the same migraine episode?

Do you understand that if at any stage you need to ask us any questions you can give us a call, email us or use our live chat feature?

Do the following apply to you?
The medication is for my own use
I will read the information leaflet supplied with the medication
I am over 18 and I agree to identity verification checks
I have completed this questionnaire myself and fully understand all the information
My responses are honest and accurate, and I understand that this is necessary for a safe medical assessment
I agree to the terms & conditions, privacy policy, & data sharing policy

What is the name of your GP surgery and do you consent to us contacting them about your treatment?

Do you consent to us accessing your GP records? This is advised so we can clinically assess suitability.