The Importance of Dosage with Migraine Medications

As someone who has struggled with migraines since childhood, it's very easy for me to list the abortive migraine medications that have worked for me and those that absolutely have not. In fact, until recently, I thought it was a rather black and white concept - either a medication was in the "yes, it's an option" column or it was exiled to the "no, it's not an option" space. However, it turns out that just like every other facet of migraines, there are several factors regarding whether or not prescription medication successfully aborts a migraine.

Does dosage play a role in migraine treatment?

Did you know that the right dose of migraine medication is critical for its success?

Let me explain how I learned this.

My experience

For many years, I used Fioricet as my abortive migraine medication. I only knew that Imitrex did not work for me. When Fioricet stopped working, or rather, when I started getting rebound headaches from needing the abortive medication too often, my previous doctor switched things up. During the past year, I've tried several additional abortive medications. Most of them provided a small amount of relief, but only one actually seemed to successfully abort my migraines. The challenge? It is an injectable medication in which I was only given 4 doses per month.

My migraines were more frequent than that. And sometimes, a migraine required 2 doses to be absolved fully. It left me feeling like migraine owned my life.

Learning more about treatment options

When I switched doctors and began being seen at a headache clinic, I learned SO much about my treatment options.

Preventive medications

One reason I needed abortive medication so often was because I wasn't on any migraine prevention medication. My former doctor had told me there were no safe options for a pregnant female or one trying to conceive. It turns out this isn't actually true.

Doses, frequency, and quantity prescribed

In addition to creating a regimen involving some preventative prescriptions, my new doctor asked about the abortive medication options I'd been utilizing up until that point. It wasn't the prescriptions themselves that he was struck by, rather the dose, frequency, and quantity prescribed.

For example, the injection medication I mentioned above? I was originally prescribed 15mg/1ml. My new doctor prescribed 60mg/2ml - which is four times stronger. In addition, I went from being given 4 vials per month to 10 - therefore covering significantly more migraine days.

Was I under-dosed?

Next, the doctor asked me about dosing for the medications that hadn't worked in the past. It turns out I'd been under-dosed on those as well.

When you don't get enough of a medication, it's automatically set up to fail. It can't beat a migraine when there isn't enough of it in your body!

Here's the fascinating thing - each of those medications now has the space to be retried, at the correct dose, to see if they are options for my migraine toolbox.

Did I suffer from endless attacks unnecessarily?

At first, I was furious at this concept. Had I unnecessarily suffered from endless days of migraines because I wasn't prescribed the correct medication dosages to relieve my pain? I'll never know the answer to this question. I also don't know that the under-dosing was intentional. It may have been because I am a female, I was in my twenties or early thirties when these medications were initially prescribed, I was working with ultra-conservative doctors, or because I have a complicated medical and medication history.

The answer could be any or all of the above, and it's impossible to determine any more than that.

However, I wanted to share this experience because I think it's important to confirm the dosing and frequency of any medication you take. And if it's not being successful, I think it's worth asking if the dose or frequency can be increased before you're switched to another medication, and the current one is labeled a failure.

I'd love to know if anyone else has experienced anything similar. How did you take your learnings and move forward in your migraine care?