Are You on the Right Migraine Medication?

By Alene L. Brennan, RYT

3 min read

I’m 43 years old and have been getting migraines since childhood. Over the years, I've worked closely with my neurologist and made significant changes to my diet and lifestyle, all of which have helped to reduce the frequency and intensity of migraines. However, with the world of migraine treatments constantly evolving – and sometimes overwhelming – I can’t help but to have a touch of FOMO (fear of missing out). Am I on the best medications for me? Is there something better out there that I’m missing out on?

Am I experiencing medication FOMO?

Every other day, there seems to be a new medication advertised, another success story from a fellow migraineur, another podcast singing the praises of a miracle drug. It's like being at a buffet with all of these choices but not being able to sample anything. How can you “window shop” medications?

Am I alone in this strange sense of FOMO? How do we find that perfect fit - the most relief with the fewest side effects?

Should I doubt my doctor's recommendations?

How do we understand which medications are in our best interest, especially when we're wondering if our doctor's recommendation could be influenced by the latest pharmaceutical rep's visit? I hate to even call this out because I trust my neurologist, and I need her because I don’t have a medical degree – she does. But if I’m being honest, you hear so much about the influence that they get from the pharmaceutical industry and insurance companies, it plants a seed of doubt.

If you’ve experienced any of this doubt and overwhelm, then I want to share how I’m working through this in hopes that I might help you as well. And as always, I want to hear your experience too in the comments below. We are strongest when we bring our collective experience and knowledge together!

How can we leverage our expertise of migraine?

The first thing I need to remind myself of is that I know my body best, I’m the one living it in all day every day. It’s my job to advocate for my body. I also remind myself that I have zero clinical education. My neurologist is the expert when it comes to reading my MRIs and understanding the nuances of medications. So, this is a collaborative approach. It can’t be me against her. We are both working towards the same outcome – bring me the maximum relief from migraines with the fewest side effects.

How do I collaborate with my neurologist?

Here are some tips that I’ve used to have a collaborative discussion with my neurologist.

Be Informed: To start this discussion, I track my symptoms in advance of my appointment and do my best to educate myself of medication options available. Having a basic understanding is helpful prior to the appointment.
Ask Questions: Don't hesitate to ask your doctor about the benefits and side effects of the medication they're prescribing. Ask why they believe this is the best option for you.
Trust Your Instincts: If something doesn't feel right or if you have doubts, now is the time to speak up. Again, you’re advocating for your body and your health. And if you don’t feel like you’re getting the support you need, it's okay to seek a second opinion.

Remember even with your best efforts and the best care team, finding the right treatment plan for your migraines may take some time and patience.

Now I want to hear from you. Please share below what has worked for you in identifying the best medication plan for you?

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Prettymomma Member
Thank you Alene for sharing this. It is so important to be an advocate for your self. I am so glad that you mentioned that! I am very blessed to have a great Neurologist who really listens to me. I try to make my time with them very valuable by prepping for my appointment in advance with research on new medications, any cares and concerns I have, and new things going on in my health that we need to address and etc. We usually discuss new medications, their side effects and weighing them as to whether it would be worth it to try them or not. I feel comfortable enough that any research that I find I will bring up to him and see what he thinks about it. For example, last year we were discussing whether I should try Vyepti or not. We decided to give it a go. This one was a little more complicated in that I needed to either go to the hospital or have a visiting nurse administer it in my home. But we tried it 3 separate times. Unfortunately, it did not help, but it was worth it to me and to him to do the necessary work involved to get it done. I used to have a Neurologist several years ago that was the exact opposite. He did not listen to me, he was not interested in any medicines that I brought up, he only wanted me to take Topomax, or Nortriptyline, both of which not only didn't help, I had reactions to. I ended up having to leave and find a new Neurologist. This was not easy because he was in with a big group and I had asked to switch to a different Dr and they said they did not do that. I also didn't want to have to go through having to start all over again with a new Dr that doesnt know you or what is going on with you. That is very hard as well. Ohh, and did I mention that I don't like change?😀 But I am glad that I did because I have been going to the same Neurologist now for 12 years and it was one of the best moves I have made. Anyway, I know this is winded but I hope this adds to what you have said. Please take care!😀
1. Alene L. Brennan, RYT Moderator & Contributor
 <inline-mention username="Prettymomma" user-id="7002652"/> thank you so much for taking the time to share your experience here. I'm sorry to hear that you had such a discouraging experience with your previous neurologist. That's so discouraging when you don't feel like it's the right fit but they won't let you switch to another provider in the practice. It doesn't make sense to me. You would think that they would want to keep you in the practice. I've come to realize over the years of working with so many doctors that it's not personal when they don't let you switch. It's simply their practice policies. That said, I'm thrilled to hear that you now have a wonderful and quiet collaborative neurologist. He sounds like he was worth the effort to find. It's wonderful to have someone who will truly sit and collaborate with you, as your doctor did with discussing the medications. And props to you for always being so prepared for each appointment. That can make such a difference in the outcome of your appointment. Thanks so much for taking the time to share this. It's encouraging and inspiring to all of us to do the same. - Alene, moderator 
2. Alene L. Brennan, RYT Moderator & Contributor
 It's true Holly! In a world that is constantly changing, it's not ideal to have migraines thriving on change. I'm so grateful that we at least have this community of people here who can truly relate. - Alene, moderator
Felix Member
I live in the UK. The healthcare is free but has now become not fit for purpose. I have a doctor who is not knowledgeable about migraines ( this is the second doctor I’ve moved to) . I am on a 30 month waiting list to see a neurologist. I can’t afford to go private. I have self advocated for my health for a long time. It has been a tortuous battle to find a suitable migraine prophylaxis. My doctor trusts my deep dive double blind peer reviewed research on the internet. I will present him with medical research and tell him that I want to try a different medicine. Then I ask to speak to the clinical pharmacist to discuss interactions with the other meds I’m on for other health issues. I keep a meticulous migraine, weather and food diary, so I’ve discovered that any foods with tyramine in trigger a migraine for me, as does hot weather and obviously stress. Over 3 years I have tried various combinations of prophylactic meds, most of which I react badly to or haven’t worked. Now I am simply taking metoprolol ( only 14mg liquid) and it has reduced the frequency and severity of my migraines. I do have 2 side effects from this, insomnia and hyperactivity but I am willing to put up with these instead of blinding 3 day migraines.
1. Nancy Harris Bonk Moderator
 <inline-mention username="Felix" user-id="4832679"/> Thank you for joining the conversation. You're not alone in living with the complexities of migraine disease - we're here for you. <inline-mention username="Allyson.Ellis" user-id="3665814"/> gave you wonderful information. I'd like to add a resource in the UK - The Migraine Trust - <a href='https://migrainetrust.org' target='_blank' rel='noopener noreferrer ugc'>https://migrainetrust.org</a> I hope this is beneficial and I'm sending you pain free wishes, Nancy Harris Bonk, Patient Leader/Moderator <a href='https://migraine.com' target='_blank'>Migraine.com</a> Team 
2. Alene L. Brennan, RYT Moderator & Contributor
 <inline-mention username="Felix" user-id="4832679"/> that is wild to hear that the waitlist is 30 months! How is that even acceptable? That's certainly too long to wait for care. Perhaps that's what prompted your incredible self advocacy. It sounds like you take incredibly meticulous notes and track all the possible triggers to best support your health. I'm glad to hear that you found some medications that offer relief, although they come with some side effects. I hope that your efforts are successful and that you give yourself credit for the incredible work that you're doing - most people wouldn't go to that extent, even for their own health. You're incredibly strong and resilient. - Alene, moderator
Felix Member
Thank you for your kind words. I spoke too soon though, I’ve had to come off the Metoprolol because I’ve just had the mother of all 3 day migraine and just couldn’t bear not being able to sleep through it. At first I thought I could manage on very little sleep but the body can’t after a while. Also the hyperactivity was making me incredibly irritable and snappy. So the next medication I’m trying is Atenolol. So far I’m having a few breakthrough headaches during the week. On this med I can sleep like a baby so take it at night. We will see what happens. I am severely restricted to what I can take because I have high eye pressure which can lead to glaucoma. if my pressure has increases they may put me on Timolol which is known to reduce migraines so I may be able to try that eventually.
1. Holly Harding Moderator & Contributor
 <inline-mention username="Felix" user-id="4832679"/> Thank you so much for letting us know how things are going with us. I'm sorry to hear you experienced such a rough attack. I've heard of folks taking Atenolol and it working well- I hope this is the case for you. It's fascinating the role that blood pressure-related meds can impact migraine. Really hoping this helps you. Please let us know how things continue. And you're right, sleep is a key factor in preventing migraine- so it's important to try to get that right. We are here for you- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team 
2. Alene L. Brennan, RYT Moderator & Contributor
 We certainly wish you all the best with this new medication. It's nice that it at least comes with a good side effect of good sleep. If you're open to it, we'd love to hear how you're doing as you continue on the medication. We're glad that your sharing your story here. - Alene, moderator