When Acute Treatments Don’t Work

What can you do if your migraine pain treatments don’t seem to be working? Your doctor may suggest other treatments that may be more effective for you. For many people, combining medication and natural remedies is an effective way to manage migraine pain.

Why Do Migraine Treatments Fail?

Here are some reasons why your migraine treatment may seem ineffective:

  • Incomplete diagnosis. There are different types of migraine. They each respond to different treatments. You may need to see a headache specialist who can correctly diagnose the type you have and prescribe the appropriate treatment.
  • Wrong diagnosis. Your headaches may not be migraines, but another type of headache or pain.
  • Other terms. You may have another undiagnosed health condition that needs to be addressed before you can effectively treat your migraine.

Unidentified triggers

Are you sure you know all the triggers for your migraine attacks? Talk to your doctor about other triggers you may have missed. Keep a diary of when your headaches occur, so you can identify possible triggers that you can avoid.

Expectations

  • Are you expecting the good results from your medicine? Migraine medications taken during an attack may not eliminate the pain immediately.
  • Preventative migraine treatments also need time to work. Taking a pill for a few days doesn’t mean you’ll never have a headache again. You may need to take your migraine medication for up to 8 weeks to see if it works before switching to another medication.
  • During a migraine, you may have nausea or vomiting that prevents your stomach from absorbing the medicine. Your doctor may prescribe a nasal spray or injected medication for pain relief that may work better. They may also prescribe medication to help reduce symptoms of nausea and vomiting during a migraine.

Medicines: other options

Here are some medications your doctor may prescribe for migraine pain if your first migraine treatment isn’t working for you:

Most migraine sufferers begin treatment with over-the-counter medications such as acetaminophen or a nonsteroidal anti-inflammatory drug or NSAID (ibuprofen, naproxen, aspirin, or diclofenac).

An over-the-counter medication that combines acetaminophen or aspirin with caffeine may work better for some people.

If in pain, take over-the-counter pain relievers as directed on the label. These will not necessarily reduce the frequency of migraines, but they do work to stop the pain. They can have serious side effects, such as liver or kidney damage, or stomach bleeding.

Triptans

If your over-the-counter medications haven’t worked, your doctor may prescribe stronger medications called triptans, including:

  • Almotriptan (Axert)
  • Eletriptan (Relpax)
  • Frovatriptan (Frova)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt)
  • Sumatriptan (Imitrex)
  • Zolmitriptan (Zomig)

If a triptan is not working for you, your doctor may prescribe a combination treatment of a triptan with naproxen (Treximet) which may relieve your pain.

CGRP inhibitors

Calcitonin gene-related peptide (CGRP) is a protein that your body makes around your brain. It can cause inflammation and severe migraine pain.

A new class of migraine treatments called CGRP inhibitors target and block this protein or its receptor to stop migraine attacks. You can also take CGRP inhibitors to prevent migraines and help make them less frequent. They understand:

  • Atogepant (Qulipta)
  • Erenumab (Aimovig)
  • Eptinezumab (Vyepti)
  • Fremanezumab (Ajovy)
  • Galcanezumab (Emgality)
  • Rimegepant (Nurtec)

CGRP inhibitors are either injections or pills that you take yourself at home or receive intravenously at your doctor’s office. Many people see benefit after 1 month, but your doctor may increase the dose if you don’t see significant pain relief after 3 months.

Selective 5HT-1F agonists

A new treatment for acute migraine pain is lasmiditan (Reyvow), a selective 5HT-1F agonist. It’s a pill that you take once a day, but no more than 4 days a month. It is the first of a new class of drugs called ditans.

Lasmiditan may also be a good option for people who cannot take triptans due to heart problems. Triptans narrow your blood vessels to relieve migraine pain, so they may not be safe for people with cardiovascular disease or poorly controlled high blood pressure. Lasmiditan treats migraine pain without narrowing blood vessels.

Ergot alkaloids

This is a special type of painkiller used to treat severe, throbbing headaches. Your doctor will only prescribe them for you if other types of medication do not work for you. You can take them in pill, suppository, or nasal spray form.

Antiemetics

These drugs relieve nausea:

  • Chlorpromazine (Thorazine)
  • Droperidol (Inapsin)
  • Metoclopramide (Reglan)
  • Prochlorperazine (Compro)

Neurostimulators

Also called neuromodulators, these are devices that can treat an acute migraine that is already in progress or help prevent migraines. Neurostimulators use electrical currents or magnetic action to dampen the brain waves that trigger migraines.

Some neurostimulating devices are wearable, but other types are implanted surgically. They may be a good option for you if other migraine medications haven’t worked or if you overuse them and find no pain relief.

Boomerang effect

If you think your migraine medication isn’t working for pain relief, don’t increase your dose or take it more often to see if it does the trick. Overuse of painkillers can make headaches worse.

Pain relievers containing butalbital (Fiorinal, Pronal, or Trinal) or opioids are more likely to cause overuse headaches. This is because you may develop a tolerance towards them, so they seem less effective.

Prevent migraines

To prevent migraines from occurring, your doctor may prescribe one of these medications:

  • Medicines for high blood pressure, including beta-blockers like atenolol (Tenormin), metoprolol (Lopressor), or propranolol (Inderal), or an angiotensin antagonist called candesartan (Atacand)
  • Anticonvulsants like sodium valproate (Depacon) or topiramate (Topamax)
  • Tricyclic antidepressants like amitriptyline (Elavil) or nortriptyline (Pamelor)
  • Ketorolac (Toradol), a stronger NSAID
  • Calcium channel blockers like flunarizine (Sibelium)
  • CGRP monoclonal antibodies

Natural remedies for migraine

Medication isn’t the only way to manage your migraine pain. Natural treatments and lifestyle changes can also provide relief.

Hot or cold treatments: Apply heat or cold to your face, head or neck. Heating pads can relax tense and tense muscles. Ice packs can numb the pain, so your pain seems less intense.

Dark and quiet space: When the pain starts, move to a dark, cool, quiet room if possible. Avoid noise and bright light. Try to relax and sleep if you can.

Caffeine: A small amount of caffeine can relieve migraine pain, but don’t overdo it. Too much caffeine can trigger recurring headaches.

Therapeutic massage: Shiatsu or self-massage on certain pressure points on the head or neck can relieve migraine pain.

Relaxation techniques: Stress is a common migraine trigger. Manage it with techniques like biofeedback or meditation.

Herbs and Supplements such as magnesium or butterbur can help soothe migraine symptoms. Talk to your doctor before trying them.

Acupuncture, alternative treatment, performed by a trained provider, may help relieve the long-term pain of migraines.

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