What to do when nothing's working for your migraines
Everyone knows that there will occasionally be that killer migraine that doesn't respond to treatments that usually works for you, but what do you do when your usual treatments just aren't working for your usual migraines? When nothing seems to be helping or your treatments aren't working anymore, it's time for a reassessment.
Review your headache pattern
Using a migraine diary, like the one on this site, start keeping track of your migraine episodes and all the medications you're using -- both prescription and over-the-counter. Over time, your headache pattern can change and those treatments that may have worked well for the type of migraines you got when you were 20 may not work as well for migraines during middle age.
You might also discover that you're using medications more than you thought. Keeping a diary is a great way to make sure that you're not using your acute migraine medications (like Excedrin or the triptans) more than just a couple days each week. When people begin overusing these medications—even when it's "just" over-the counter medications like Tylenol or Excedrin—you can develop medication overuse headaches. Medication overuse headaches typically don't respond to taking more medication. Also, overusing acute migraine therapies can prevent other treatments from being effective.
Review your medications
Write down a list of everything you take for your headaches to review with your doctor—prescription drugs, over-the-counter therapies, and nutritional supplements and herbs. Sometimes, a bad combination of therapies keeps individual treatments from working well. Other times, the drug dosing is wrong.
You should also review what you used in the past for your migraines to see what might be worthwhile trying. Often when patients tell me, "My doctor told me I tried EVERYTHING for my migraines and nothing helps," it turns out that they tried a couple blood pressure medications and six different antidepressants, but there are still a lot of classes of medications they haven't tried.
Review your other health problems
Sometimes treatments stop working because you have other health problems causing symptoms that also need to be treated. Headache is one of the most common symptoms for medical conditions and can be caused by infections, anemia, hormone problems, autoimmune problems, etc. If your treatments stop working or you have tried a few standard migraine therapies and they really don't make a difference, see your doctor for a complete physical to make sure nothing else is going on.
Also, be sure to let your doctor know about other pain problems you may be having. I've learned to never let patients tell me, "Well, I do have other pain problems, but I'm just here for my headaches." If you have widespread pain from fibromyalgia, for example, you probably get migraines, too. And if your doctor tries to treat your migraines separate from your other fibromyalgia symptoms, you probably won't get a lot of relief. Do you also have problem low back pain? The imbalances in the spine joints and muscles from your back can affect your head and neck muscles and shouldn't be ignored.
Get a fresh look
If you and your healthcare provider have stalled with what do to next—take a break and get a second opinion. A fresh look often brings up new ideas that haven't been tried. Even we doctors who consider ourselves to be headache experts send our own problem patients to our colleagues for another opinion. A new perspective can often be very helpful. So don't be afraid to ask for a second opinion when you and your doctor are getting frustrated.
How much has your migraine disease changed or evolved over time?