You have a range of options, so it’s worth the effort to find the right fit.
Historically, migraines have been difficult to treat. It took centuries for doctors to understand what was going on in the migraine brain, so they blamed it on things like an imbalance of blood in the body or even demonic possession. This in turn led to a history of bizarre medical treatments for migraine, such as bloodletting and trepanation (i.e., drilling a hole through the skull).
Today’s migraine sufferers have better options, thankfully. Doctors know more about migraines than ever before, and the treatment options are more sophisticated and effective. But how do you know if your treatment is working?
Treating Mild or Occasional Migraines
“For mild migraines without nausea or vomiting, the recommendation is [usually] over-the-counter medications,” says Sylvia Mohen, MD, neurologist in New York City. “They tend to be cheaper and they have less side effects than the triptans or the ergots or some of the other more migraine-specific medications.”
OTC medications for migraine includet acetaminophen (e.g., Tylenol) and non-steroidal anti-inflammatories (e.g., ibuprofen). Learn the difference between OTC pain relievers here.
If these keep your migraines at bay, your migraine treatment is working. On the other hand, OTC pain relievers may not be working for you if your migraines are still causing pain after two or three hours of taking medication, or if you find yourself taking these medicines more frequently or in larger amounts than recommended.
Another sign your OTC pain relievers are not enough for treating your migraines is if you’re experiencing nausea or vomiting. In this case, your doctor may recommend antiemetics to supplement your treatment. These help to prevent vomiting, but they also appear to help treat the migraine itself.
Treating Moderate Migraines
When OTC pain relievers aren’t enough, you have many treatment options to relieve moderate or frequent migraines. One of the most common options is triptans. These medicines help constrict the blood vessels, which helps lessen the severity of the migraine. The earlier you take a triptan, the more effective it will be.
Triptans should result in less severe migraines. In fact, if you take them early enough, they may virtually abort the migraine altogether.
That said, triptans might not be working for you if you find yourself needing to take them too often. You should not take triptans more than 10 days per month, as this can result in something called medication overuse headache. In other words, too much of this migraine treatment could actually trigger more migraines.
In this case, you may benefit from a different treatment option. Your doctor may try a different type of triptan, or a different category of acute migraine treatment. Alternatively, they may recommend a preventative medication.
Treating Chronic or Severe Migraines
If you have chronic migraines that are not responding to other therapies, preventative migraine treatment might be for you. These treatments include beta blockers, antidepressants, and anticonvulsants.
How do you know if your preventative migraine treatment is working? “A sign that preventative treatment is effective is actually seeing an overall drop in migraine burden. You may have … headaches almost every other day, and on the medication, you may drop down to maybe one headache a week and it may be less severe,” says Dr. Mohen.
That said, you may have to be patient. Preventative migraine treatments may take up to three months to see results. Note that preventative migraine treatment does not guarantee zero migraine episodes.
“If your headache burden hasn't really decreased significantly, it may be time to either increase the dose or explore other options,” says Dr. Mohen. “there's a lot of great treatment options out there and I think if you have a great relationship with your doctor, you can easily find one that'll work best for you.”
Sylvia Mohen, MD, is a neurologist at New York Neurology Associates, P.C.
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(hopeful piano music)
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(Narrator) Migraines are historically difficult to treat
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and migraine sufferers in the past have endured treatments
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like bloodletting or trepanation,
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also known as drilling a hole through the skull.
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Luckily, that's not the case today.
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(hopeful piano music)
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For mild migraines without nausea or vomiting
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the recommendation is if they respond
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to simple over-the-counter medications to stick with those.
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They tend to be cheaper and they have less side effects
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than the triptans or the ergots
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or some of the other more migraine-specific medications.
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So if you don't really see a dramatic improvement
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in migraine, then it's a good point to really sit back
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and look at how effective you feel the treatment is.
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If your headache burden hasn't really decreased significantly,
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it may be time to either increase the dose
or explore other options.
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Signs that over-the-counter pain relievers aren't working
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are incomplete resolution of the migraine.
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If you're still having a lot of pain at two hours,
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three hours out, it's not working for you.
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If the migraine rebounds, so maybe after the medication,
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say you take something over-the-counter and it wears off
in like six hours
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and you have to take something again,
that can be an indication
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that you need to step up
to a more migraine-specific treatment.
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When we decide to revisit a treatment plan,
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it's usually because something is not working.
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The preventative you're taking is not decreasing
the overall headache burden you're having,
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or you're just not able to get up to a dose that's effective
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to actually treat your headaches.
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At this point, we really step back and we look at why
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the treatment plan didn't work.
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Is it because you couldn't tolerate the medication?
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Is it because the medication itself wasn't effective?
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Or is it because there's maybe a better option out there
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for you in terms of your lifestyle fit.
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There are several different options for the preventative
treatment of migraine.
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There's a number of oral medications.
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There's also a new class of monoclonal antibodies
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that target the neurotransmitter CGRP.
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That's widely understood now to be what we think
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starts the migraine signaling cascade,
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and there are also other injectable options as well
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in the botulism class
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that have been widely used
for the past 10 to 15 years.
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There's a lot of great treatment options out there
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and I think if you have a great relationship with your doctor,
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you can easily find one that'll work best for you.
- Acute migraine: treating early. American Migraine Foundation, 2009. (Accessed on July 28, 2020)
- Acute treatment of migraine in adults. Waltham, MA: UpToDate, 2020. (Accessed on July 28, 2020)
- Koehler PJ, Boes CH. A history of non-drug treatment in headache, particularly migraine. Brain. 2010 Aug;133(8):2489-500.
- Preventative treatment of migraine in adults. Waltham, MA: UpToDate, 2020. (Accessed on July 28, 2020)