Chronic Disease Management
Neurologic, Sleep & Pain Management — Online Care
Migraines that derail your day. Sleep that never feels restorative. Aches and pains that have become part of your daily routine. These are not conditions you have to just push through. A licensed healthcare provider can evaluate your symptoms and help you develop an approach that may improve your quality of life based on your individual situation.
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🧠 Everyday neurologic, sleep, and pain concerns — more manageable than you think
Headaches, trouble sleeping, and everyday pain are three of the most common reasons people seek medical care, and three of the most commonly undertreated. People often assume they just have to live with them. The reality is that many of these conditions respond well to the right approach, and a licensed healthcare provider can help figure out what that looks like for you.
This page focuses on the everyday versions of these conditions: migraines and recurring headaches, sleep difficulties and insomnia, and common pain including muscle, joint, and nerve-related discomfort. It is not a neurology or sleep specialist clinic, but our providers are well-equipped to evaluate these concerns, discuss treatment options that may be appropriate, and help you understand when a specialist or in-person evaluation is the right next step.
One important note upfront: MyPhysician360 does not prescribe controlled substances. That means no opioids for pain, no benzodiazepines, and no controlled sleep medications like Ambien or Lunesta. There is still quite a bit we can do within that scope, and we will always be upfront about when something falls outside it.
What this page covers
Migraines and recurring headaches, including both acute treatment and prevention. Sleep difficulties and insomnia, using non-controlled approaches. Muscle, joint, and nerve-related pain, including evaluation and non-opioid management options. This page does not cover conditions requiring neurologist or sleep specialist involvement such as epilepsy, multiple sclerosis, Parkinson's disease, sleep apnea requiring a sleep study, or complex chronic pain requiring opioid management.
⚠️ Call 911 or go to the ER immediately for any of these
A sudden, severe headache described as the worst headache of your life. Headache with fever, stiff neck, confusion, vision changes, or light sensitivity. Sudden one-sided weakness, numbness, or difficulty speaking. First-ever seizure. Loss of consciousness. New back pain with loss of bladder or bowel control, saddle numbness, or rapidly worsening leg weakness (possible cauda equina). Headache during pregnancy or the postpartum period. Headache in a person with a known immune-compromising condition. These require emergency evaluation, not a telehealth visit.
Condition deep-dive
💥 Migraines and headaches — online treatment and prevention
If you live with migraines, you know they are not just bad headaches. They are events: hours or days of throbbing pain, light and sound sensitivity, nausea, and a recovery period that can feel almost as draining as the migraine itself. Migraines are a neurological condition, and many people experience significant improvement with an individualized treatment plan. Many people who have been managing with over-the-counter medications, or just enduring them, do not realize how much better things can get with the right treatment.
Migraine vs. tension headache vs. chronic daily headache
- Migraine Usually one-sided, pulsing or throbbing pain of moderate to severe intensity. Often accompanied by nausea or vomiting, sensitivity to light and sound, and worsened by physical activity. Some people experience aura, which is visual disturbances, tingling, or other neurological symptoms that appear before the headache. Migraines typically last 4 to 72 hours without treatment.
- Tension headache Usually feels like a tight band or pressure around both sides of the head. Less intense than migraine and not usually accompanied by nausea or light sensitivity. Very common and typically responds well to over-the-counter pain relievers, rest, and stress management.
- Chronic daily headache and medication overuse headache Headaches occurring 15 or more days per month. Can develop from episodic migraines or tension headaches, and sometimes from overuse of headache medications, including over-the-counter options like ibuprofen and acetaminophen. This cycle is called medication overuse headache, and it is important to identify and break. A provider can help you understand if this pattern applies to you.
How migraines are treated
- 💊 Acute treatment: stopping a migraine in progress For migraines that have already started, the goal is to stop the attack as quickly as possible. Triptans (such as sumatriptan, rizatriptan, and naratriptan) are the most effective migraine-specific medication class available. They work by targeting the pain pathways specific to migraine and are significantly more effective than over-the-counter pain relievers for most migraine sufferers. Triptans are not appropriate for everyone, including some patients with significant cardiovascular disease, so your provider will review whether they are right for you. Anti-nausea medications can be added when nausea is a significant part of the attack. NSAIDs help for milder attacks or in combination. Newer migraine-specific medications, including CGRP-targeted therapies, may also be appropriate for some patients, although insurance requirements and specialist involvement vary.
- 💊 Preventive treatment: reducing how often migraines happen If migraines are frequent (roughly four or more per month), significantly disabling, or not responding well to acute treatment, preventive medication is worth discussing. Beta-blockers such as propranolol have the strongest evidence among blood pressure medications for migraine prevention. Certain calcium channel blockers may be appropriate in selected situations. Certain antidepressants (amitriptyline, nortriptyline) and certain anti-seizure medications (topiramate, valproate) are also used preventively with good evidence. The goal is not to eliminate every migraine but to meaningfully reduce their frequency and severity.
- 📓 Tracking triggers Keeping a headache diary is one of the most useful tools in migraine management. Common triggers include alcohol (especially red wine), disrupted sleep, dehydration, skipping meals, bright lights, strong scents, and hormonal fluctuations. Identifying triggers does not eliminate migraines, but it meaningfully reduces frequency for many people. A headache diary can also help determine whether preventive treatment should be considered.
Headaches that need in-person evaluation before treatment
New headaches after age 50 that differ from previous patterns. Headaches progressively worsening over days or weeks. Headaches triggered by coughing, straining, or exertion. Headaches with neurological symptoms such as vision changes, facial drooping, or limb weakness. Headache following a head injury. These patterns warrant in-person evaluation and may need imaging before being attributed to migraine or tension headache.
Still enduring migraines without a proper treatment plan? A licensed healthcare provider can help you find options that work, including prescription medications.
Start a VisitCondition deep-dive
😴 Sleep difficulties and insomnia — online evaluation and treatment
Good sleep is foundational to almost every aspect of health: mood, energy, focus, immune function, weight, and cardiovascular health. When sleep is consistently poor, the effects ripple outward in ways that can be hard to trace back to their source. Many people have been living with poor sleep for so long they have accepted it as normal.
Insomnia is more common than most people realize. Roughly one in three adults struggles with sleep regularly, and about one in ten has chronic insomnia (difficulty sleeping on most nights for three months or more). Most cases are never formally evaluated or treated, and that is a significant gap, because effective treatment exists.
Common types of sleep problems
- →Trouble falling asleep — lying awake for an hour or more, mind racing, unable to wind down
- →Trouble staying asleep — waking frequently through the night or too early, unable to return to sleep
- →Non-restorative sleep — spending enough time in bed but waking feeling unrefreshed
- →Stress and anxiety-driven insomnia — sleep that worsens significantly with life stress, worry, or mood changes
- →Sleep disrupted by pain, reflux, or other medical symptoms — where an underlying condition is the primary barrier to sleep
Sleep apnea requires a sleep study — not a telehealth visit
If you snore loudly, wake gasping or choking, feel excessively sleepy during the day despite adequate time in bed, or have been told you stop breathing during sleep, sleep apnea is a possibility. Sleep apnea cannot be diagnosed through a telehealth visit alone. It requires a sleep study, either at home or in a lab. It is also linked to increased cardiovascular risk including resistant hypertension and atrial fibrillation, which is why it should not be ignored. A licensed healthcare provider can discuss your symptoms and help you understand whether a sleep study is the right next step.
How sleep difficulties and insomnia are treated
- 🧠 Cognitive Behavioral Therapy for Insomnia (CBT-I) — the most effective long-term treatment CBT-I is not just "thinking yourself to sleep." It is a structured, evidence-based approach that targets the thoughts and behaviors that perpetuate insomnia: spending too much time in bed awake, watching the clock, building anxiety around sleep, and irregular schedules. It is considered the most effective treatment for chronic insomnia, and it often produces longer-lasting improvement than medication alone, without side effects or dependency risk. CBT-I is available through digital programs if an in-person therapist is not accessible. A provider can point you toward appropriate resources.
- 🌙 Sleep hygiene: the basics that actually matter The changes most consistently supported by evidence include going to bed and waking at the same time every day (including weekends), keeping the bedroom cool, dark, and quiet, avoiding screens within an hour of sleep, limiting caffeine after early afternoon, and not lying in bed awake for extended periods. These are genuinely effective for many people, not just common sense advice.
- 💊 Non-controlled medications for sleep MyPhysician360 does not prescribe controlled sleep medications such as Ambien, Lunesta, or benzodiazepines. Several non-controlled options are available and can be helpful for the right patient. Trazodone (a low-dose antidepressant used off-label) is commonly used for difficulty staying asleep. Hydroxyzine (an antihistamine) can help with anxiety-driven sleep difficulties. Doxepin at low doses is FDA-approved specifically for early morning awakening. Melatonin is available over the counter and may be most helpful for regulating sleep timing rather than general insomnia. These medications are used for selected patients and are not approved for every type of insomnia, so your provider will discuss which option fits your specific pattern, other health conditions, and what you have already tried. Medication is generally more helpful as a bridge during a difficult period than as a long-term standalone solution.
- 🔍 Addressing what is driving poor sleep Poor sleep is often driven by something else: depression, anxiety, chronic pain, GERD, thyroid problems, medications, or alcohol use. Treating the underlying contributor often improves sleep significantly. A provider will ask about these as part of the evaluation.
Condition deep-dive
🦴 Pain management — non-opioid treatment online
Pain is the most common reason people seek medical care, and also one of the most complex. Not all pain is the same, and what is driving it shapes what the most helpful approach looks like. This page focuses on pain conditions that can be managed effectively without opioids or controlled substances: muscle and joint pain, nerve-related symptoms, and inflammatory pain. For pain that does require controlled substances, in-person management with an appropriate provider is the right path, and we will tell you that clearly.
Types of pain we commonly help with
- 🏃 Muscle and joint pain Aches and soreness from overuse, strain, inflammation, or musculoskeletal conditions. This includes back pain, neck pain, shoulder pain, and joint pain from conditions like osteoarthritis or tendinitis. Often well-managed with anti-inflammatory medications, physical therapy guidance, and topical treatments.
- ⚡ Nerve-related pain and tingling Burning, shooting, or electric pain, tingling or numbness, or a pins-and-needles sensation that follows a nerve distribution. Common causes include sciatica, carpal tunnel syndrome, diabetic neuropathy, and post-herpetic neuralgia (nerve pain following shingles). These types of pain often do not respond well to standard pain relievers but may respond to medications that target nerve pathways specifically.
- 🔥 Inflammatory pain Pain associated with inflammation from conditions like gout, bursitis, or tendinitis. Gout in particular, which causes painful uric acid crystal deposits typically in the big toe or ankle, has very effective medical treatment that many people do not know is available through a simple provider visit.
Non-opioid treatment options for pain
- 💊 NSAIDs (non-steroidal anti-inflammatory drugs) Ibuprofen, naproxen, and prescription-strength options like meloxicam and diclofenac reduce both pain and inflammation. Prescription-strength NSAIDs are considerably more potent than over-the-counter doses. NSAIDs are not appropriate for everyone — they carry real risks with extended use including GI irritation, kidney effects, and cardiovascular considerations. They should not be used beyond 20 weeks of pregnancy, and multiple NSAIDs should not be combined unless your provider specifically instructs you to do so. Your provider will review whether they are appropriate for your situation.
- 💊 Topical treatments Topical diclofenac gel and other topical NSAIDs deliver anti-inflammatory medication directly to the area of pain with much lower systemic absorption than oral medications. Particularly useful for joint pain in accessible areas. Topical lidocaine and capsaicin cream also have roles in certain types of nerve and localized pain.
- 💊 Medications for nerve pain Gabapentin and other selected medications for neuropathic pain may be considered when clinically appropriate and permitted under applicable prescribing requirements, which vary by state. These work differently from standard pain relievers and can be effective when other approaches are not, but they require careful clinical review of your situation, other medications, and overall health before prescribing.
- 💊 Muscle relaxants (non-controlled) For muscle spasm and tension-related pain, non-controlled muscle relaxants such as cyclobenzaprine and methocarbamol can help. These are generally used short-term. They commonly cause drowsiness and should not be combined with alcohol or other sedating medications.
- 💊 Short-course corticosteroids For acute inflammatory flares including gout, bursitis, and significant tendinitis, a short course of oral prednisone can rapidly reduce inflammation and pain. Not appropriate for long-term use, and repeated courses are generally avoided because of cumulative side effects. Very effective for the right acute situation.
- 🏋️ Physical therapy and movement For most musculoskeletal pain, physical therapy or a structured home exercise program is one of the most effective interventions available. A provider can recommend appropriate exercises, advise on activity modification, and help facilitate a physical therapy referral when that is the right next step.
What MyPhysician360 does not prescribe for pain
MyPhysician360 does not prescribe opioid pain medications of any kind, including codeine, tramadol, hydrocodone, oxycodone, morphine, or fentanyl. If your pain requires opioid management, your primary care physician or a pain management specialist is the appropriate provider. We will always be direct with you about when a situation falls outside what we can helpfully manage through telehealth.
How online care can help
💻 What a telehealth visit for these conditions can do
Migraines, sleep problems, and everyday pain are all conditions where a thorough conversation is the most important diagnostic tool, which makes them a natural fit for telehealth. A licensed healthcare provider can assess your symptoms, discuss your full health picture, and build a treatment plan without you needing to leave home.
| What a telehealth visit can do | What requires in-person or specialist care |
|---|---|
| Evaluate recurring headaches and migraines and discuss a treatment plan | New or worsening headaches requiring imaging (CT or MRI) |
| Initiate or continue migraine medications when clinically appropriate | Thunderclap headache or worst headache of your life — go to the ER |
| Discuss preventive migraine medications when appropriate | Neurological symptoms alongside headaches — requires in-person neurologist |
| Evaluate sleep difficulties and discuss non-controlled treatment options | Suspected sleep apnea — requires a sleep study |
| Discuss and prescribe non-controlled sleep aids when appropriate | Controlled sleep medications (Ambien, Lunesta, benzodiazepines) — not available here |
| Evaluate muscle, joint, and nerve pain and recommend non-opioid treatment | Opioid pain management — requires in-person physician or pain specialist |
| Recommend and prescribe non-opioid medications when appropriate | Suspected fractures, joint infections, or acute injuries requiring imaging |
| Evaluate gout and discuss treatment options for flares and prevention | Complex chronic pain conditions requiring specialist pain management |
| Help coordinate referrals to neurology, rheumatology, pain management, or sleep medicine | Epilepsy, MS, Parkinson's, and other neurological conditions requiring specialist care |
Honest about our limits — and still genuinely helpful
We are upfront that we do not prescribe controlled substances and that we are not a neurology or sleep specialist service. But within that scope, there is a lot we can do. Most migraines, many sleep problems, and a wide range of everyday pain conditions respond well to non-controlled medications and approaches that a licensed healthcare provider can evaluate and prescribe. And when something needs a specialist or in-person care, we will tell you clearly and help you figure out the next step.
What to expect
🗓️ Your visit, start to finish
Here is what a headache, sleep, or pain management visit looks like.
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1
Describe what you are dealing with
Share your symptoms in the intake form: what they feel like, how often they happen, how long they last, what makes them better or worse, what you have already tried, and your relevant health history and medications. The more specific you are, the more useful the conversation will be. |
2
Talk with your provider
A licensed healthcare provider reviews your intake and asks follow-up questions. This is a real conversation, not a form with a prescription attached. Your provider will be honest about whether your situation is a good fit for telehealth management or whether imaging, a specialist, or in-person evaluation is the better path. |
3
Get a plan
Your provider reviews the most likely cause of your symptoms and discusses appropriate next steps. That might mean a prescription sent to your pharmacy, lifestyle or behavioral changes, a referral to a specialist, or a combination. For conditions outside our scope, your provider will explain why and point you in the right direction. |
4
Follow up as needed
Many of these conditions involve some adjustment over time. If a medication is not working well, if symptoms are changing, or if a referral becomes needed after trying initial treatment, follow up. Getting these conditions well-managed usually takes more than one conversation. |
What to bring to your visit
For headaches: how often they occur, how long they last, what they feel like, whether you get aura, and current or past medications tried including what helped and what did not. For sleep: how long you have had trouble sleeping, your typical sleep pattern, what you have already tried, and other symptoms like snoring or daytime sleepiness. For pain: location, how long you have had it, what makes it better or worse, any imaging you have had, and medications you take or have tried.
Care connected to your pharmacy
🏪 Your prescriptions. Your pharmacy. Ongoing.
Triptans, NSAIDs, preventive migraine medications, non-controlled sleep aids, and nerve pain medications are commonly available at retail and mail-order pharmacies, although availability and insurance coverage vary. Many are available as affordable generics. When prescription treatment is appropriate, your provider may send it electronically to the pharmacy you already use.
- ✓Prescriptions sent electronically to your selected pharmacy when clinically appropriate
- ✓Many medications in this category available as low-cost generics
- ✓No required membership to access our telehealth services
- ✓No controlled substances — we are always upfront about what we can and cannot prescribe
Frequently asked questions
❓ Your questions answered
Can I get migraine medication through telehealth?
Yes. A licensed healthcare provider can evaluate your symptoms and initiate or continue triptan medications (the most effective migraine-specific treatment class) as well as preventive options when appropriate. You do not need to be in person for effective migraine treatment. If your headaches are new, significantly different from previous ones, or accompanied by neurological symptoms, your provider may recommend in-person evaluation or imaging before prescribing.
Can stress cause migraines or make pain worse?
Yes, very directly. Stress is one of the most common migraine triggers, and it can amplify nearly every type of pain. Physiologically, stress activates inflammatory pathways, increases muscle tension, disrupts sleep, and affects how the nervous system processes pain signals. For people with migraines, stress management is a genuine clinical tool, not just a general wellness suggestion. The same is true for chronic pain and sleep problems, where stress and anxiety consistently worsen outcomes. A provider can help identify whether stress is playing a significant role in your symptoms and discuss approaches beyond medication.
Can you help with sleep problems if you do not prescribe Ambien or Lunesta?
Yes, quite a bit. Those medications are controlled substances that we do not prescribe, and they are also not always the best long-term approach to insomnia since they carry dependency risk and do not address underlying causes. We can discuss and prescribe effective non-controlled options including trazodone, hydroxyzine, and low-dose doxepin, depending on your specific sleep pattern and health history. We can also point you toward CBT-I (Cognitive Behavioral Therapy for Insomnia), which has the strongest long-term evidence for insomnia and is available through digital programs. For many people, this combination of behavioral strategies and non-controlled medication is more effective than a controlled sleep drug alone.
What pain medications can you prescribe?
We can prescribe a range of non-opioid pain medications including prescription-strength NSAIDs (like meloxicam and diclofenac), muscle relaxants, topical pain relievers, nerve pain medications such as gabapentin (where clinically appropriate and permitted), and short-course corticosteroids for inflammatory flares. We do not prescribe opioid pain medications of any kind, including tramadol and codeine. If your pain requires opioid management, we will tell you that clearly and recommend appropriate in-person care.
What is a triptan and how is it different from regular pain relievers?
Triptans are a class of medication designed specifically for migraines. Unlike general pain relievers such as ibuprofen or acetaminophen, which reduce pain through broad mechanisms, triptans work by targeting serotonin receptors involved in migraine specifically, essentially interrupting the migraine process rather than just reducing pain after the fact. For many people, triptans are significantly more effective than over-the-counter options. They work best when taken early in an attack, and they come in several formulations including tablets, nasal sprays, and auto-injectors.
I have had back pain for months. Can telehealth actually help with that?
Often yes. Chronic back pain has a range of non-opioid treatment options that a provider can evaluate and recommend, including prescription NSAIDs, muscle relaxants for spasm, nerve pain medication if there is a radiating or nerve component, and guidance on physical therapy and movement. If your back pain suggests nerve compression, a significant structural concern, or has features like leg weakness or bladder and bowel changes, in-person evaluation and imaging are the right next steps, and we will tell you that directly. Many cases of chronic back pain can be meaningfully helped through the right non-controlled approach.
What is CBT-I and is it really better than sleep medication?
CBT-I stands for Cognitive Behavioral Therapy for Insomnia. It is a structured program, typically six to eight sessions, that addresses the thoughts, behaviors, and habits that keep insomnia going. It teaches skills like sleep restriction therapy, stimulus control, and techniques for managing the anxiety that builds around sleep. Multiple studies have shown CBT-I often produces longer-lasting improvement than sleep medication and without side effects or dependency risk. It is available through digital programs if you do not have access to an in-person therapist. Medication can still play a role, particularly as a short-term bridge, but CBT-I tends to produce more lasting change.
Can you diagnose and treat gout?
In many cases, yes. Gout often has a characteristic presentation that a provider can assess through a detailed history. Note that first episodes or atypical presentations may require additional evaluation before confirming the diagnosis. When gout is the most likely explanation, NSAIDs or a short course of colchicine or prednisone can rapidly reduce pain during an acute flare. Long-term, if gout attacks are frequent, uric acid-lowering medication can prevent future attacks. Gout is often undertreated because people assume they just have to wait it out. Effective help is often available through a telehealth visit.
Is this visit HSA or FSA eligible?
MyPhysician360 visits may be HSA and FSA eligible. Check with your plan administrator to confirm based on your specific plan.
Helpful resources
📚 Learn more
Authoritative patient resources from leading organizations in headache, sleep, and pain medicine.
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💥 Migraines Migraine — Symptoms, Causes, and Treatment American Migraine Foundation Visit AMF → |
😴 Sleep and insomnia Insomnia — Overview, Causes, and Treatment American Academy of Sleep Medicine Visit AASM → |
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🧠 CBT-I for insomnia Cognitive Behavioral Therapy for Insomnia National Sleep Foundation Visit NSF → |
🦴 Chronic pain Chronic Pain — Understanding and Managing It National Institute of Neurological Disorders and Stroke Visit NINDS → |
You do not have to just push through it.
Whether it is migraines, poor sleep, or everyday pain that has become part of your routine, a licensed healthcare provider can evaluate what is going on and discuss an individualized treatment approach. No waiting room. No required membership. Available in most states.
HSA & FSA eligible — check with your plan administrator | No required membership
Medical disclaimer: The information on this page is for general educational purposes only and does not constitute medical advice. Neurological, sleep, and pain conditions require individualized evaluation by a licensed healthcare provider. MyPhysician360 does not prescribe controlled substances, including opioid pain medications, benzodiazepines, or controlled sleep medications such as zolpidem, eszopiclone, or suvorexant. Sudden severe headache, headache with neurological symptoms, first seizure, sudden one-sided weakness or difficulty speaking, and loss of consciousness require emergency evaluation — call 911. New back pain with loss of bladder or bowel control, saddle numbness, or rapidly worsening leg weakness requires immediate emergency evaluation. Suspected sleep apnea requires a sleep study and cannot be diagnosed through a telehealth visit alone. Epilepsy, multiple sclerosis, Parkinson's disease, and other complex neurological conditions require in-person specialist management. NSAID medications carry risks including GI, renal, and cardiovascular effects and should not be used beyond 20 weeks of pregnancy. Gabapentin prescribing is subject to applicable state regulations. Prescribing decisions are made by a licensed healthcare provider on an individual basis. MyPhysician360 services are available in most states. Services are not currently available in Mississippi or Alaska.