Assessing your treatment plan
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Every day you follow the plan. You swallow a fist full of pills, watch your triggers, chart your progress, and pray that migraine stays away. You don’t skip meals, stay up late, or get dehydrated. Yet sometimes, in the back of your mind, a small voice breaks through.

“Is this the best I can hope for?”

Do you know the answer? How would you know if your treatment plan needs updating? Do you know when it’s time to make a change? Your answers to the following questions may help determine if your current plan is working or if it’s time for something new. Please remember that every patient is different. Only you and your headache specialist can decide what, if any, changes are necessary. These questions are designed only to help you evaluate what issues may be appropriate to discuss with your doctor.

Is your doctor a true headache specialist?

YES GREAT! This means that your doctor has been specially trained to treat headache disorders AND that he or she practices exclusively with headache patients. Give yourself a pat on the back.
NO Darn. That’s too bad. Maybe we can help you find one?

 

Does your doctor treat you with respect as an equal partner?

YES YIPEE! You’ve got a keeper.
NO You’re the one with the most to gain or lose. You deserve to have a doctor who will work with you, not dictate to you. Do you think he or she is redeemable? If not, maybe you can find a new one on this list.

 

Is your doctor willing to advocate on your behalf with your insurance provider?

YES YAY! It can be a real challenge to convince an insurance company of a needed treatment. Kudos to your doctor for being willing to try.
NO Have you been stuck trying to negotiate with insurance? Maybe it’s time to ask your doctor to intervene? If he or she won’t play ball, there’s always that list of specialists you can try.

 

Have your symptoms changed?

YES Have you reported the change to your doctor? If so, what was the result? Do you feel satisfied that your concerns were appropriately addressed?
NO Predictability is half the battle, so it’s good to know that things are relatively stable. Just remember to report any changes to your doctor if they occur.

 

Are your attacks increasing in frequency or severity?

YES Are you and your doctor working to change this?
NO Here’s to hoping they are mild and infrequent!

 

Do you have access to migraine-specific abortive treatments?

YES So you’re using either a triptan (Imitrex, Amerge, Axert, Frova, Maxalt, Relpax, Treximet, or Zomig), an NSAID (Aleve, Cambia, ketoprofen, toradol), or ergotamine (DHE) to stop a migraine attack in progress? Your medicines may be pills, dissolving tablets, nasal sprays, injections, or patches, depending on your specific needs. Thumbs up!
NO Do you have a medical reason why you cannot take a migraine-specific abortive? Maybe you tried one (or more!) and had no good results? Have you tried them ALL…even the brand name and generic versions in all delivery methods? Has your doctor suggested layering multiple classes (triptan + NSAID)? Maybe it’s time for a new conversation.

 

Are you symptom free within 2 hours of taking your abortive?

YES All right!
NO Perhaps it’s time for a change? Talk to your doctor about your options.

 

Do symptoms return in less than 24 hours?

YES Maybe it’s time to ask your doctor about a longer-lasting abortive.
NO Woo hoo!

 

Do you have symptoms that are not improved by your abortive treatment?

YES Have you asked your doctor what else might help? Maybe there is a different abortive or other treatment you can try?
NO Great!

 

Do you need to abort more than 2 attacks per week?

YES Have you asked your doctor for help? Taking pain medicines more than 2-3 times a week can increase your risk of developing medication overuse headache. The fewer attacks you have, the easier it will be to abort them and prevent more from occurring.
NO Wonderful! Using pain medication less than 2-3 times a week reduces your risk of medication overuse headache.

 

Do you have access to preventive treatments?

YES Good to hear!
NO Do you think you might need a preventive? If so, it may be time to talk to your doctor about your options.

 

Have you been taking it as prescribed for at least 90 days?

YES Way to stick with it!
NO Keep on trying! It can take that long to know if a treatment is really working.

 

Has your preventive reduced the frequency and/or severity of attacks by 50%?

YES Keep up the great work!
NO Have you and your doctor talked about ways to improve your results?

 

Are there side effects that impact your quality of life?

YES While not all side effects are avoidable, your doctor may have ideas on how to reduce their impact.
NO Great news! The absence of intolerable side effects will help you stick with the treatment.

 

Do you need to take additional medications to address side effects?

YES That’s not all bad news. Sometimes they are necessary.
NO Is that because you have no side effects or because you don’t have access to treatments? Maybe your doctor has ideas on how to help.

 

Do you have access to at-home rescue treatment?

YES Excellent! Rescue treatments reduce the need for ER visits.
NO Maybe it’s time to ask your doctor how you can avoid ER visits when your abortive fails.

 

Does your rescue treatment work consistently?

YES What a relief!
NO Perhaps it’s time to discuss the issue with your doctor.

 

Have you needed to access emergency or urgent care since your last treatment change?

YES Have you asked your doctor how to reduce the need for these visits?
NO That must feel really good.

 

Do you have and use a migraine toolkit in addition to medication?

YES Using comfort measures from a toolkit can reduce the need for pain medicine. Keep up the good work!
NO Do you need some ideas on how to create one?

 

Do you have a good support system?

YES A good support system can really help you manage migraine effectively.
NO Sorry to hear that. Have you considered an online or in-person support group? Everyone deserves to have good support!

 

Are there untreated co-morbid conditions that interfere with your migraine treatment success?

ES Maybe it’s time to ask your doctor for help or a referral to a specialist.
NO Whew! You are very lucky.

 

Can you do the things you want and need to do without migraine interference?

YES So glad to hear that your life isn’t controlled by migraine!
NO You’re not alone. Don’t give up. Keep working for better migraine control.
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