To Supplement Treatments or Not?

For a long time, I was on the same preventative migraine medication - Qulipta. And I knew it was working at least semi-decently because the frequency and severity of my migraine attacks had decreased shortly after starting the medication, and held steady for a fairly long time.

How well was the preventative working for me?

In fact, I was repeatedly going 3 months at a time without talking to my migraine specialist, seeing him only at my routine Botox appointments for a follow up visit along with the injections in my head, neck, jaw and shoulders. This was a record for me, someone who had frequently been ending up in the emergency room or the infusion chair to abort debilitating migraines. It seemed like everything was status quo, and I was super grateful. But then, there was a transition.

What changed?

I was getting more breakthrough headaches. They weren’t always migraine attacks, but it was enough that I was reaching for medication, or needed to ice my head or lay down. It was interrupting my schedule and my workday, and I wasn’t used to this. This wasn’t the deal Qulipta and I had established.

Should I change treatments?

I reached out to my doctor with an electronic message, and shared that it wasn’t that my migraine management had disappeared or completely quit on me, but I didn’t think it was working as well as it had before, and I was wondering what her thoughts were on migraine management. I didn’t necessarily want to change my existing treatment, but I knew I needed some additional help.

This is when she started by offering me options to change preventative migraine medication - which I told her I wasn’t ready to give up on my current treatment yet, and then we began having an open conversation about abortive migraine medications - what I’d tried, what I hadn’t, what had worked for a short time, and had never worked at all.

What migraine treatments have I used?

I had been using oral pills for breakthrough migraines a long time ago, but then I started getting rebound headaches from that same medication.

In recent years, I'd had intramuscular injections to use when the pain was severe. I wasn't to use more than 2 a day, more than 2 days a week, but prior to this change in migraine trajectory, I didn't need to. That prescription was sufficient to keep me moving and on my feet.

What did we decide I should try?

During my conversation with my specialist, she brought up two new ideas - one was a nose spray that was relatively new on the market that her patients had been having success with, and the other was a muscle relaxer meant specifically for headache pain, addressing the strain of the muscles in the head and neck. We agreed that I would try both of these things, separately, to see if either provided relief for my somewhat routine breakthrough migraines. We also agreed that we would only give these two prescriptions as long as I felt was reasonable, and if trying these didn't help me get back into my routine of feeling like my migraine was managed, I would agree to try a different proactive migraine treatment.

Why was I having breakthrough headaches?

In addition, we discussed something I was anxious to address - why was I getting more breakthrough episodes in the first place?

We talked about how it could be a side effect of not sleeping well, of one or several of my other health conditions, one or several of my other medications, grinding my teeth/clenching my jaw, stress, or any number of issues, and that it would be easier to try to manage them than to pinpoint the cause of them.

Does this story sound familiar to any of you? How do you know when you don't want to change your existing treatments, but you may need something to get your migraine management to the place you'd like it to be?