Signs that a chronic migraine treatment isn’t working

One of the most challenging aspects of treating chronic migraine can be finding an effective therapy.

Chronic migraine is characterized by having 15 or more headache days per month, with migraine symptoms on at least 8 of those days, with symptoms persisting for at least three months.

While moderate-to-severe headaches are the most common symptom, chronic migraine is much more than headaches. It is a complex neurological condition that can cause a wide range of symptoms, including visual disturbances (aura), nausea, changes in mood, fatigue, and sensitivity to light, sound, and smells. Episodes are often intense, debilitating, and significantly impact a person’s quality of life.

People with chronic migraine typically require two types of therapies in their treatment plan. One is acute therapies, also called abortive treatment. These are taken at the first sign of a migraine attack to reduce the severity and duration of the attack.

The other type is called preventive or prophylactic therapy. These are therapies that are taken on a continuous schedule to prevent migraine attacks from occurring and to reduce the number of headache days a person experiences in a month.

Identifying and avoiding triggers—anything that acts as a catalyst for a migraine attack—is also an essential part of treatment.

Finding a treatment that works

There are numerous acute and preventive therapies that a healthcare provider may prescribe. Different therapies work in different ways, and different therapies work for different people.

As a person living with chronic migraine, it’s important to recognize when a treatment isn’t working. Keeping a journal or diary where you track your symptoms can help you and your healthcare provider track how your migraines are responding to treatment and recognize when migraines are not responding to treatment.

Symptoms that don’t improve, migraines that continue to interfere with quality of life and functioning, increased use of acute therapies, and treatments that feel less effective can all be signs that migraines are not responding to treatment.

Reasons why a migraine treatment may not be working

If a migraine treatment isn’t working, isn’t working well enough, or is not working as well as it used to, there are numerous factors that you and your healthcare provider will need to consider:

How long you’ve been using this therapy

With some preventive therapies, it can take several months (and sometimes up to 6 months) before you notice a significant difference. You may need to give a therapy more time before making a decision about adjusting a dosage or switching treatments.

Adherence to treatment

In order for a therapy to work as intended, it needs to be used exactly as prescribed. Skipping doses, missing doses, or pausing therapies can all impact how well a medication is working. Overuse of acute medications can also contribute to more frequent and severe headaches, which is known as medication overuse headache (MOH).

Increased exposure to triggers

Mentioned above, identifying and avoiding triggers is an important part of treatment. Recent events, changes in routines, and your overall health should be a part of your discussion with your healthcare provider. Changes to stress levels, sleep habits, diet, and changes in hormone levels are common examples. Having a coexisting health condition can also affect migraine management, and you should discuss your medical history and overall health with your healthcare provider.

Other types of headaches and head pain

Headache days are one of the main diagnostic criteria for migraine. Headache days refer to any day with head pain, not only days where a person experiences a migraine. People with migraine are not exempt from other types of head pain. Tension-type headaches, headaches related to neck pain, and sinus headaches are a few examples. Your healthcare provider may investigate the possibility of other causes of head pain.

Medication interactions

Other medications or drug interactions can trigger migraines. If you are taking medications or receiving treatment for another health condition, this is important information to share with the healthcare provider you are seeing for migraines. Your healthcare provider should be aware of any co-occurring conditions. They should also have an up-to-date list of all medications you are taking, including prescription medications, over-the-counter medications, and supplements. Alcohol and recreational drugs are also important topics to discuss—and be honest about.

A medication has become less effective

Sometimes a medication will work well for a period of time and then work less well after more time. The medical term for this is tachyphylaxis, the decreasing response to a medication after multiple doses. It can be described as developing a tolerance to a medication.

Migraine treatment is different for everyone

There are multiple acute and preventive treatments for migraine. If one isn’t working or is no longer working, your healthcare provider may recommend switching to another. It’s important to remember that there is no best treatment for migraine, only the treatment that works best for an individual.

Migraine and headache disorders can have many causes and contributing factors. When it comes to information about your health and your diagnosis, there is no substitute for working with a healthcare provider.