Doctor's Note for a Migraine: A Physician's Guide

Migraines are one of the most under-documented reasons for legitimate sick leave in the U.S., and it's not because they aren't real — it's because the thing a migraine attack demands from you (dark room, no screens, no motion, no talking) is the exact opposite of what it takes to drag yourself to a clinic. I'm Dr. Adam Z. Kawalek, and here's how to handle a migraine absence clinically and professionally.

The short answer

Yes, you can get a same-day doctor's note for a migraine through SickSlip. A board-certified physician reviews your symptoms and issues a signed note for the days you need off. For a typical acute migraine, a 1–2 day absence is medically appropriate. For status migrainosus (a migraine lasting more than 72 hours) or atypical neurologic symptoms, you need in-person care, not a telehealth note.

Why migraines are a legitimate absence reason

A migraine isn't a headache. Migraines are a neurologic disorder with well-documented functional impairment — severe throbbing head pain, nausea and vomiting, extreme sensitivity to light and sound, and in many people, visual aura, numbness, or difficulty speaking. The American Migraine Foundation estimates that migraines cost U.S. employers about $13 billion per year in lost productivity. For the roughly 15% of Americans who get migraines, a bad attack is functionally disabling for the duration of the episode.

When the clinical literature treats migraines as a legitimate cause of acute disability, there's no reason HR should be the one doubting it. A physician-signed note from a board-certified MD with an NPI on file converts a defensible medical reality into defensible documentation.

How many days off can I get for a migraine?

Most acute migraine attacks resolve in 4–72 hours. Here's how I think about it clinically when reviewing a request:

• 1 day: Typical acute migraine attack. Attack onset, triptan or NSAID taken, patient is in a dark room and will likely be functional by the next day. This is the most common length I issue.
• 2 days: Prolonged attack, medication-resistant, or hangover-day (the post-migraine fatigue and cognitive fog that lingers 24 hours after the head pain resolves). Appropriate when the patient is describing day-2 symptoms or has a history of prolonged attacks.
• 3+ days: Status migrainosus, by definition. At that point I recommend in-person neurology evaluation — prolonged attacks can require intravenous treatment (metoclopramide, dihydroergotamine, fluids) that telehealth can't deliver.

If your migraines are routinely lasting longer than 72 hours or recurring more than 15 days per month, that's chronic migraine and it's worth getting evaluated by a headache specialist — not for the sick note, but because preventive treatment (CGRP antagonists, beta-blockers, topiramate, botox) can dramatically reduce the frequency. A doctor's note documents the absence; it doesn't treat the underlying disorder.

When a migraine is actually a medical emergency

Most migraines, even severe ones, are managed at home. A small percentage of presentations that look like a migraine are actually something else — and those need emergency care, not a note. Go to the ER if any of the following apply:

• "The worst headache of your life" — especially if it came on suddenly (thunderclap). Can indicate subarachnoid hemorrhage.
• Headache with fever and stiff neck — possible meningitis.
• Headache with focal neurologic symptoms that are new for you — new weakness on one side, new speech difficulty, new vision loss. A migraine with typical aura can include these, but "new" or "different from my usual aura" is the phrase that matters.
• Headache after a head injury — possible concussion or intracranial bleed.
• Headache during pregnancy with high blood pressure or vision changes — possible preeclampsia.
• Headache that is the first severe headache of your life after age 50 — worth a clinical evaluation to rule out causes that aren't primary migraine.

If any of those apply, please don't ask me for a note. Please get seen in person. A note is the wrong concern when your body is signaling that something more serious may be going on.

How to get the note without making the migraine worse

Here's the practical version: pull out your phone. Turn brightness all the way down. Open SickSlip and fill out the intake form — it takes about two minutes. Describe when the attack started, the symptoms, what you've tried (triptan, NSAIDs, dark room, hydration), and how many days you need. A board-certified physician reviews your case and issues a signed note, delivered to your email inbox. Standard delivery is same-day; rush is under 10 minutes if you need to notify your employer right away.

You don't need to talk to anyone. You don't need to get on a video call. You don't need to get dressed. That's the whole point — the clinical evaluation of a routine migraine doesn't require the things that make a migraine worse.

Frequently asked questions

Adam Z. Kawalek, MD

Board-Certified Physician · Founder, SickSlip · Cedars-Sinai · Johns Hopkins

Dr. Kawalek is a hospitalist physician with 15+ years of clinical experience. He founded SickSlip to give patients fast, affordable access to legitimate medical documentation without unnecessary clinical barriers.