Changing My Migraine Regimen: Trying New Treatments

I’ve written several articles about my journey to my current treatment plan. I started with my primary care physician and saw several neurologists who at the time told me that if I was trying to conceive, I had no preventative care options, and there were only one or two safe abortive options for my migraine. I went through years where my migraines were manageable, and this sort of mediocre level of care was acceptable.

When did my migraine attacks change?

In late 2020, this all changed. During my first miscarriage, I had a migraine so bad that after days in bed, I had to visit my local ER for IV treatment. As time proceeded, I noticed that one of my migraine triggers was my hormones, and so going through IVF and even my regular period cycle was triggering migraines that I couldn’t shake with one abortive pill.

What treatment regimen did I try first?

Towards the end of 2021, I found myself at a migraine specialist who told me I had a variety of choices, whether or not I was trying to conceive. We started a regimen of alternating Nurtec and Ubrevely, and used Fioricet for breakthrough pain. I even tried Nerivio to see if the non-medicated device could help my migraines. This combination was not a homerun.

How did it change?

A few months later, I stopped those medications completely, and began Qulipta as an abortive medication. My insurance wasn’t thrilled about this and it took some appeals to several denial letters, but one I started it I noticed a big difference. My breakthrough migraines were much less frequent. And for breakthrough pain, I switched to ketoralac (toradol) injections, which almost always did the trick. Occasionally, I’d need an IV infusion to breakthrough the pain, but when I did I could go to the infusion suite in my doctors office and not the emergency room, saving a whole headache and about 8-10 hours of waiting.

This regimen worked for quite some time, and I felt grateful during all of it. This past summer I had surgery which left me with an anesthesia-triggered migraine so severe it took two days in the hospital to reduce the pain, and nearly two weeks plus a five day new medication breakthrough migraine buster to get over the migraine fully.

Why did I change my treatment plan again?

What I noticed when that migraine finally stopped is that my preventive mediation no longer seemed to be working. I was getting headaches every few days, and migraines at least once a week - a much much higher frequency than previously.

I scheduled an appointment with my migraine specialist, and we talked about the options I had to try new treatments. We decided that since I’ve at least paused in my quest to conceive another child, that we were less limited than previously, and I decided after listening to her explain the three main injectable preventive medications, that I would try Emgality. She told me it could take several months to see the full effects of the medication, but she recommended that I give it a try. We also supplemented my abortive medication options, which I’ll share more about another time.

How long do I try a treatment to know it's effective?

Several people have asked me how long I try a new treatment before deciding if it’s effective. I think this question varies person to person, and definitely requires input from the doctor. If I am taking a new medication that’s supposed to be immediately effective and after 2-3 weeks I’m still experiencing symptoms, than I would go back to my doctor and indicate that this wasn’t the right combination for me. However, on the new medication I switched to, I know that I need to give it time. My doctor and I decided on six months for a number of reasons, but that includes my own semi-vigilant monitoring of symptoms. If my symptoms become worse or more frequent, that would be a reason to reach out to my doctor to discuss if we really think waiting the full time would be worth it. To me, those things might indicate the treatment is not working.

Now, if my symptoms stayed the same, I would probably try to wait out the timing agreed upon with the doctor, but be fairly adamant at the six month mark if i hadn’t seen improvement than it wasn’t the right medication.

Of course the goal is symptom reduction or elimination, and experiencing that would indicate to me that the new treatment was effective (at least for now) and would be worth continuing to pursue, even if it needed adjustment or supplementation in the future.

How long do you tend to try a new treatment before deciding if it’s the right one for you?