Chronic migraine is a complex condition. And its treatment can be just as complicated. Often, it involves lots of trial and error.
There's no cure for chronic migraine and no one treatment that works for everyone. You might try several medications before you find a drug or a dosage that's right for you. Or a drug might work for you for a while but then become less effective. You may need to take more than one medication at a time.
Your lifestyle and daily habits play a big role in migraines. So it's also important to avoid things that could lead to headaches or make them worse and to adopt habits that improve your general health.
If you have another physical or mental health condition, as many people with migraine do, that further complicates your treatment.
Your Migraine Treatment Plan
Migraine varies a lot from person to person. You and your doctor will come up with an individualized treatment plan to manage your migraine. When creating this plan, your doctor will consider:
- How often you have headaches
- How bad they are
- How much they interfere with your life
- What symptoms you have
- How you've reacted to past treatments
- Your lifestyle and preferences
They'll also look at whether you have other conditions. Some migraine drugs aren't recommended for people with heart or kidney disease, for example. Some aren't OK if you're pregnant, nursing, or trying to get pregnant. And your doctor will need to make sure your migraine drugs don't interact with medicines you take for other health problems.
For people with chronic migraine, treatment often focuses on prevention. Preventive drugs reduce the number of headaches you get and how bad they are. You might take them as a daily pill or get them in a shot. They include:
- Anti-seizure medications
- Blood pressure medications
- Monoclonal antibodies
- Botox injections
You'll likely also take an abortive medication or medications to stop attacks in their early stages or ease symptoms once one starts. But to avoid rebound headaches, don't use them on more than 10 days a month. Depending on the type, you might take them as a pill or via a nasal spray, shot, or IV. They include:
- Analgesics, which are pain relievers ranging from over-the-counter medications to prescription drugs
- Migraine-specific drugs called triptans
- Ergot alkaloids, used when analgesics and triptans aren't effective
- Newer types of drugs called ditans and gepants, also known as CGRP antagonists (doctors can also use some gepants to prevent headaches)
Finding a Treatment That Works
It can take some time to get your medication right. And it's important to understand that successful treatment likely doesn't mean no migraines ever. But you should be able to have fewer migraine days, less pain, and shorter episodes.
Your doctor will probably start you on a low dose of preventive medicine and increase it as needed. That may mean you have to take it more than once a day. For the drug to work its best, follow your doctor's instructions closely. If that's inconvenient for you, let your doctor know.
You'll probably need to use a preventive drug for at least a couple of months before it starts to work. And you might have to keep taking it for 6-12 months before it reaches full effectiveness.
Let your doctor know if you notice any side effects. Don't stop taking your medication suddenly, or you could end up with rebound headaches or other problems. Your doctor can help you taper off.
If you end up with rebound headaches from overusing rescue medications, you may need to detox with your doctor's help.
While nearly everyone with chronic migraine benefits from medication, healthy lifestyle habits also help prevent migraine attacks. It's not always easy, but try to:
- Eat, sleep, and wake up on a regular schedule
- Lose weight if you need to
- Get regular exercise
- Manage your stress
- Drink enough liquids
- Avoid too much caffeine
Keeping a migraine diary can make it easier for you and your doctor to pinpoint things that might be causing your migraines or making them worse.
If you have depression, anxiety, or a sleep disorder, treating these conditions can help your migraines as well.
Therapies like cognitive behavioral therapy (CBT) and biofeedback can also work to prevent migraines. The FDA has also approved prescription nerve-stimulation devices that ease migraine pain for some people.
What If Treatment Doesn't Work?
If none of these things does the trick, your doctor may suggest:
- Nerve blocks. Your doctor injects a long-acting painkiller and anti-inflammatory drug near the base of your skull. This stops pain signals from traveling up into your head. It could help you go pain-free for anywhere from a day to several months.
- Trigger point injections. Trigger points are painful areas in your muscles that can cause pain signals to travel up toward your head and neck. In this treatment, your doctor injects a local anesthetic into the muscle. It relieves pain in the muscle and stops pain signals from reaching your head and neck.
See a migraine specialist if you haven’t already. If nothing seems to work, you may need to take a team approach to treatment. Your doctor can refer you to a treatment center where you can work with a team of specialists that may include:
- Mental health professionals
- Physical therapists
- Social workers
Photo Credit: Jon Feingersh Photography Inc. / Getty Images
American Headache Society: "The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice," "Understanding Migraine Medications," "Preventive Treatments," “Occipital Nerve Blocks,” “The Basics of Trigger Point Injections for Headache and Migraine,” "What to Do When Migraine Treatment Fails."
Cleveland Clinic: "Chronic Migraine."
FDA: "Treating Migraines: More Ways to Fight the Pain."