What to ask before changing chronic migraine treatment

Migraine is a type of headache disorder that can cause a wide range of symptoms. Head pain (usually severe and intense) is one of the most recognizable symptoms. Other common symptoms can include:

• Auras
• Nausea
• Vomiting
• Chills
• Fatigue
• Sensitivity to light, sound, and smells

Migraine episodes can last hours or days, and are typically disabling, preventing a person from engaging in their normal routines, activities, and responsibilities.

Chronic migraine is when a person experiences 15 or more headache days per month, with migraines on eight of those days, and they have been experiencing this frequency of symptoms for three months. There is no cure for chronic migraine, but there are treatments that can help a person manage the condition.

A treatment plan for chronic migraine typically includes a preventive therapy, which prevents migraines from happening and reduces the number of headache days a person experiences. Additionally, a treatment plan will include an acute therapy, which is taken at the start of a migraine to reduce the episode’s severity and duration.

Switching migraine treatment

Treating chronic migraine is an ongoing process, and it’s common for people with the condition to switch treatments from time to time. There are many possible reasons that a change might be needed—you’re not noticing an improvement in symptoms, a therapy is no longer working as well as it used to, a medication is causing side effects, the out-of-pocket costs are too high. Different treatments can work better for different people, for many different reasons.

Before changing a treatment

Before making any changes to your treatment plan, you and your healthcare provider will want to decide if a change is necessary, and if there are other avenues that should be explored before making a change. Here are some questions to consider:

• What are the dosing instructions? For a migraine therapy to work, it needs to be used as directed. Be honest if you have missed doses or skipped doses—and ask your healthcare provider to help you come up with strategies and solutions.
• How long does it take for the treatment to work? It can take weeks or months of regular use before you know how well a preventive therapy is working. You should also have clear expectations of what to expect from both acute and preventive therapies, including how long each takes to work and signs that the drug is working.
• Are there unidentified triggers? In addition to therapies, identifying and avoiding migraine triggers is an important part of treatment. Persistent symptoms or worsening symptoms may be caused by an unidentified trigger. Keeping a diary where you record symptoms and day-to-day activities can help identify triggers and patterns in symptoms.
• What other medications are you taking? Side effects or drug interactions from other medications for other conditions may affect how a migraine therapy is working. Create a list of all medications you are taking and share it with your healthcare provider. The list should include all prescription medications and over-the-counter medications, as well as things like supplements and vitamins. Your pharmacist can also be a good source of information about drug interactions.
• Could it be another headache disorder? Chronic migraine shares symptoms with other headache disorders, and it can be misdiagnosed. Your healthcare provider may reevaluate your symptoms and diagnosis. You may also consider getting a second opinion.

If you’ve arrived at a point where you want or need to change treatment, the first step is to make an appointment with your healthcare provider. Any changes to a treatment plan should always be done under the guidance of a healthcare provider.