Such a great question and I think it's one with which so many of us wrestle- when it comes to our medications and the frequency with which we turn to them AND when we may choose to pile on medication after medication. Which are actually helping? Which are working in concert? How would we be if we weren't taking them? When our migraine attack frequency is infrequent it can be really hard to answer these questions. When attacks are daily, this answer can be easier, but even then it can be tricky as some medications cause a rebound effect (if taken too frequently, they can cause their own migraine/headache to occur)... so, what's happening as a result of the medication? What is happening naturally? I believe the only way to really know is to work with your doctor to help evaluate your treatment regimen and ultimately conduct an experiment in which you do not take the medication in question for a window of time during which you keep a journal about your migraine attack pattern while you are not taking the medication in question and compare that to a solid window in which you are. Not only checking for frequency, but as you said, for gradation of pain - so, that journal would keep track of the scale of your pain and other symptoms. It wouldn't be fun to go without, of course, so perhaps your test window wouldn't be super long (and sorting those details out would be between you and your doctor). Of course, the reverse of this- if you had been doing so, is to review a migraine journal or diary you've been keeping and compare how you were before the treatment to how you are now. Not all of us have done that kind of record keeping to have as a baseline to look back on as we try new meds. Have you been keeping a journal? Thinking of you- Holly (migraine.com team).