Migraine evaluation for patients from Chitwan (Bharatpur)
Migraine is a clinical diagnosis. The International Classification of Headache Disorders (ICHD-3) criteria are used to distinguish migraine with or without aura, chronic migraine, tension-type headache and medication-overuse headache. Chitwan and Bharatpur patients are about four to five hours from Kathmandu by road, with a short flight option. The visit is structured so that diagnosis and next steps are decided in one trip.
A headache diary covering at least four weeks is more useful than a single consultation snapshot. It records frequency, severity, triggers, associated nausea or light sensitivity, and the number of acute-medication days. That pattern determines whether preventive treatment is appropriate and whether painkillers are causing rebound headache.
- Migraine with or without aura
- Chronic migraine (15 or more headache days per month)
- Tension-type headache and mixed headache patterns
- Medication-overuse headache
- Cluster headache and other trigeminal autonomic headaches
Related: Migraine Care → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Planning the visit from Chitwan (Bharatpur)
From Bharatpur, take the Mugling-Narayanghat road toward Kathmandu (roughly 150 km, 4-5 hours), or fly to Kathmandu and continue to Durbar Marg.
Bring the headache diary, a complete medication history including over-the-counter painkillers and triptans, prior imaging or EEG reports, and a list of questions. The clinic is at Durbar Marg, Opposite of Yak & Yeti Hotel. Telemedicine follow-up is available for appropriate cases after the initial assessment.
- At least four weeks of diary entries
- Names and doses of every headache medicine used
- Prior MRI, CT or EEG reports
- A note of triggers, aura symptoms and family history
Treatment approach
Acute treatment is matched to attack severity and frequency, with limits to avoid medication-overuse headache. Preventive treatment is considered when attacks are frequent or disabling, with a clear discussion of benefits, risks, alternatives and the time needed to judge response.
The plan is reviewed against the diary rather than symptoms alone. Lifestyle factors such as sleep regularity, hydration, caffeine and stress are addressed alongside medication, and follow-up may be in person or by telemedicine for appropriate cases.
| Question | What it helps decide |
|---|---|
| How many headache days per month? | Whether prevention is worth considering |
| How many acute-medication days? | Whether medication overuse is contributing |
| What happens during an attack? | Migraine versus other headache types |
| What has already been tried? | Which options are genuinely new |
When to seek urgent care
Most migraine is managed as an outpatient condition, but some headaches need urgent assessment. A sudden thunderclap headache, headache with fever and neck stiffness, new weakness or speech change, headache after a head injury, or a new headache pattern after age 50 should not wait for a routine appointment.
- Thunderclap headache reaching peak intensity within a minute
- Headache with fever, neck stiffness or a rash
- New weakness, facial droop, speech difficulty or vision loss
- Headache after a head injury or with persistent vomiting