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If you are currently experiencing the worst headache of your life, had a recent head injury, or have a fever, this can be a life-threatening emergency. Please contact the emergency or go to your nearest hospital.
—Please choose an option—Abu DhabiAl AinDubaiSharjahAjman
YesNo
Taking medications as needed, when I get migraine headachesTaking medications to prevent migraine headaches.Other
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No, never taken any medicines beforeNo, never had side effects that bothered meYes
Tell us more about the side effects and the medication
Less than once a weekOnce a weekTwice a weekThree or more times a weekI do not take headache medicine
Less than once a monthOnce a monthTwice a monthThree times a monthFour or more times a monthDon't know. I'm taking medicine regularly to prevent headaches
Left side of the headRight side of the headOne side and other times the other sideBoth sides togetherOther
Top of the headAcross the foreheadLeft templeRight templeLeft eyeRight eyeNeckOther
PulsatingThrobbingStabbingAchingSharpDullPressureTighteningOther
A few seconds (less than 1 minute)A few minutes (less than 1 hour)1 hour or longerOther
0 to 4 hours4 to 12 hours12 to 24 hours (less than 1 day)24 to 72 hours (1-3 days)More than 72 hoursOther
NauseaVomitingSensitivity or avoidance of loud soundsSensitivity or avoidance of bright lightsNone apply
Tell us more
Include vitamins, herbs, and over-the-counter products, like pain relievers and sleep aids and WHY you are taking them.
Out of pocketInsuranceupload emirates insurance details (if available)
Insurance provider: Insurance card no: Upload Insurance card: Feel free to leave any additional comments here:
Google MapDelivery Location Google Map: (Please Share your Google Map Link) Delivery Location Neighborhood/Area: Street Name/No: Address Details:
Title: Mr.Ms. First Name: Last Name: Mobile Number: E-mail:
After you submit your request, a licensed medical provider will review your information. You will be notified by email/contact number when that provider has reviewed your request and, if appropriate, made care recommendations.