The Anxiety of Switching Effective Migraine Treatments

I have lived with migraines for most of my life. For some number of years, they were infrequent, and I generally dealt with them as one-offs. I’d reach out to my doctor or I’d take the PRN medication I had on hand, and that was enough.

When did my migraine frequency change?

In 2020, my migraines transitioned from episodic to chronic, often in synch with my hormones. Two particularly difficult migraines after early miscarriages left me in the emergency room, begging the physician on call for some relief.

How did I find my treatment plan?

At the end of 2021, I began working with a migraine specialist, and within a couple of months, I found a regimen of preventive and abortive medications that left me in a really good spot. I only had 1-2 migraine days a month, and I was completely satisfied with this - it was the best it has been in as long as I could remember, and I didn’t want to do anything to change that.

What was I doing to prevent attacks?

At the time, I was doing three things to prevent migraines - taking a medication called Qulipta, a supplement called EBH4, and receiving Botox for migraines every 3 months. I also had medications like Nurtec, Fioricet, and eventually intramuscular injections of ketorolac and Bendaryl to use at home for abortive situations.

Was I ready to change my preventive plan?

In the summer of 2023, I went under anesthesia to have a hiatal hernia repaired, and when I woke up, I had a serious migraine. It took the hospital three days to get it under control, and it lingered for another two weeks once I got home. During a telehealth appointment with my doctor, we decided to use a short course of steroids to try to break up the migraine, and then I was asked the dreaded question…

Do you want to switch your preventative medication from Qulipta to Emgality?

This question caused me so much anxiety because up until that point, Qulipta had been doing it’s job fairly well. Did I want to jump ship because I’d had one bad experience? On the other hand, the reason I’d delayed switching to injections for migraine prevention in the first place had been in case I was going to experience another pregnancy, and at this point that’s unlikely. So, I decided to take the leap, and switch to Emgality - a once monthly injection which was hopefully going to provide me better migraine prevention than Qulipta was doing at the moment.

Was Emgality working for me?

That was in July, and for the next five months, I did Emgality injections instead of taking my daily Qulipta pill. I noticed I was having more like 5-10 migraine days a month, but I also knew I should give the Emgality six months to take full effect.

Well, right around that time, I experienced the worst migraine of my life. One that was caused by the swelling in my brain from bacterial meningitis, and one that has now stayed with me for the last 12 weeks.

Has my migraine attack subsided?

I’ve been in and out of the hospital, I’ve seen my migraine specialist, a new neurologist, and a neurosurgeon (due a brain abscess from the meningitis) and each of them offered me medications to try to disrupt this headache cycle. I also tried different treatment options such as occipital nerve blocks, continued Botox for migraines, muscle relaxers, and a variety of migraine related medications. However, the pain still lingers.

Am I switching back to Qulipta?

A few weeks ago, my neurologist asked me if I wanted to switch back to Qulipta from Emgality. It was clear that the Emgality, administered twice during the long length of this intractable migraine, was not helping. Qulipta had been successful in the past, so was I willing to try it again?

I said yes, anxious to try literally anything that could help. It’s now been two weeks, and I’ve found myself emailing my neurologist and my migraine specialist, asking how much longer we give it before we move to the sort of last resort - a hospital admission with IV specific migraine medication protocols. I’ve been told to be patient a little longer - maybe 1-2 weeks, but my hopes aren’t currently high. I’m desperate to see a change in my migraine status as soon as possible and I know this community can always relate to that.

If you’ve changed preventative medications in the past, I’d love to know what caused you to switch medications, and if the switch was successful or if you ended up returning to your old medication or even trying something totally different?