Is Your Migraine Treatment Working?
With a battalion of drugs to cut migraine frequency, are you making progress in your migraine treatment?
Migraine Treatment: Your Game Plan continued...
In battling frequent migraines, Goldstein believes in bringing all migraine
drugs to the table -- not just preventive medications. That includes:
- Pain relievers
- Anti-inflammatory drugs
- Anti-nausea drugs
- "Migraine-stopping" drugs
- Certain supplements (feverfew, magnesium, and vitamin B-2 – may help curb
There is some evidence that even Botox can cut migraine frequency.
"The headache sufferer should have everything available to them to treat
the headache effectively," Goldstein tells WebMD. "We have to weigh the
benefits against the side effects of each drug. Also, does the patient want to
take a medication on a daily basis?"
In deciding the strategy, "the question becomes, do we want to prevent
migraines altogether -- if that's possible -- or do we aim toward treating each
headache individually?" says Goldstein. "For most folks, it may be a
combination of both."
For example, many women have menstrual migraines, says Goldstein. He says
these women may need a daily preventive medication to control chronic migraine
problem, plus another drug -- like an anti-inflammatory or migraine stopper --
to halt a menstrual migraine when it starts.
Stopping the headache is what matters most, Goldstein says. "My personal
feeling is that if a patient can stop a headache within 15 or 20 minutes, it
doesn't matter how many headaches they actually have. After all, there are
people who have only a few migraines a month, but those migraines last three
Taking Control of Your Migraine Treatment
The process of finding the right drugs and dosages takes time, explains
Nissan. "It's not an exact science. There's no cookbook approach. There are
no absolutes. And there are a lot of options. Some patients respond to multiple
drugs; some respond to only a few."
A headache specialist will start with one drug, keep the initial dosage low,
and gradually increase it or change medications. The patient keeps a headache
diary to track the treatment's effectiveness and side effects.
Typically, patients take a drug for two to three months to test the effect,
Nissan says. How do you know you're on the right track?
"Often, the goal is to drop down to one or two headaches a month,"
he tells WebMD. "We can achieve that with many patients. With others, we
will achieve some reduction -- but we might not get 50%."
Once migraine frequency is under control, it may be possible to taper off
preventive medication, Nissan notes. "Patients have to be very stable, with
little or no headache," he says. Once they are stable they can transition
to using a migraine stopper medication for the occasional migraine, adds
Nissan. Unfortunately, a lot of people don't fall into that category.