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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 migraines)

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 days."

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.

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