Doctor for a migraine attack in Berlin — house call sensible?

When a house call for migraine is the right route

A severe migraine attack is more than headache. The combination of pulsating unilateral pain, nausea often with vomiting, marked light and sound sensitivity, sometimes visual aura, makes a trip to the practice nearly impossible — waiting under fluorescent light is torture. If you are a known migraineur and oral therapy at home (triptan plus antiemetic) does not work or you cannot keep down the triptan because of vomiting, a house call is a good option. We come, dim the lights, speak quietly and work efficiently. With a classic migraine history we can inject a triptan subcutaneously (sumatriptan injection) — bypassing the GI tract and reliably effective even with vomiting. In parallel an antiemetic by injection.

Crucially, not every severe headache is migraine. For any new headache, any headache that feels different from your usual migraine, any sudden 'thunderclap' headache, any headache with fever and neck stiffness, any headache with focal neurology (speech disturbance, hemiparesis, visual disturbance beyond familiar aura), any headache with altered consciousness and any headache after trauma we must consider secondary causes: subarachnoid haemorrhage, meningitis, cerebral venous thrombosis, stroke, intracerebral bleed. These pictures belong in hospital with CT and MRI, not in an outpatient house call. We screen clinically — orienting neuro-status, neck stiffness, pupillary reaction, visual fields — and decide according to findings.

For chronic recurrent migraine the house call is acute help, not the solution. Long-term migraine care belongs in a GP or neurology practice — prophylaxis with beta-blocker, topiramate or modern CGRP antibodies, trigger management, lifestyle, physiotherapy, stress reduction. For frequent attacks we recommend a neurological review on the next working day. On request we send a short doctor's letter to the practice.

Example: known migraineur with refractory attack

A 34-year-old patient in Mitte with long-standing migraine calls on Saturday morning — since the previous evening pulsating right-sided headache, vomiting, light and sound sensitivity, oral triptan not retained. We come late morning. History matches her usual migraine, no thunderclap, no trauma, no fever, neuro-status orienting unremarkable. We inject sumatriptan subcutaneously and MCP intramuscularly. Within 45 minutes the headache subsides clearly, vomiting stops. We discuss prophylaxis review with the GP — at three to four attacks per month a prophylaxis conversation is due. Phone follow-up Sunday: no relapse, exhausted but convalescent.

Migraine house call: what we do

• History: known migraine, character compared to prior attacks, aura, triggers.
• Orienting neuro-status: pupils, visual fields, speech, hemiparesis, neck stiffness, coordination.
• Triptan injection (sumatriptan subcutaneous) for classic attack without contraindications.
• Antiemetic injection (MCP or dimenhydrinate) against vomiting.
• Dark, quiet room, fluids, sleep — standard recovery environment.
• Red-flag screening: thunderclap headache, fever + neck stiffness, neurological deficits, trauma, altered consciousness — hospital indication.
• Recommendation for neurological follow-up in frequent attacks for prophylaxis review.