Is Your Migraine Treatment Working?

You have a range of options, so it’s worth the effort to find the right fit.

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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.”