Waiting for the Next Dose

By Holly Harding

1 min read

When the efficacy of monthly key medications fade with time, how do we handle the inevitable increase in pain and other symptoms as we wait for the next dose? Botox is injected every 10-12 weeks and some CGRPs are injected or administered monthly (like Aimovig, Ajovy, Emgality, and Vyepti). Many of us take a combination of Botox along with a CGRP. As the timing for administering these treatments cycles, we may notice efficacy fading toward the end of the treatment window when coverage weakens with time. In this video, Holly explores this challenge.

In the comment section below, please let us know if you experience this issue and if so, how do you handle it? Do you clear the decks of plans or employ other treatments such as rescue medications to provide coverage until the next dose of your preventative? We look forward to learning from you.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Gagirl2772 Member
<inline-mention username="Holly Harding" user-id="3755969"/> I would like to say that at the end of the cycle of fading or when it symptoms seem to cycle back I always seem to have a rescue Sumatriptan nasal spray that doesn't interfere with the treatment at hand but aids in the gap of my treatment. When I explain to my doctors that it's a vicious cycle and that we cannot predict when and where and how these happen but want to limit them. We also want to arm ourselves at all times with "rescue" immediate help when we know that our next full healthy dose is not near as I say to my self. I also say that not everyone's rescue is the same but it helps to find that temporary rescue to have on hand and discussions with your doctor is helpful because all treatment can be only temporary as we all know with migraines. I look forward to finding a cure so maybe one day we can help one person. I watched a show that Soundwaves in the head are a new way to assist in many new advanced therapeutic trials for migraines and I am all up for trying new things myself. ANYTHING to stop this pain and suffering. <img src="/content/images/2024/08/19/e63fee47d07167da28534984ba14429b_medium.jpg" alt="Christy Phillips Green member since 2020" class="uploaded-image"/>
1. Holly Harding Moderator & Contributor
 <inline-mention username="Gagirl2772" user-id="3702808"/> That Soundwaves show sounds fascinating- something I'll have to check out. Thank you so much for sharing your strategy for using your triptan as a bandaid rescue solution as you are in the "gap" period. That's a great suggestion for all of us to have a backup rescue treatment that we can call on for when the attacks increase in frequency/severity. None of us wants to end up in the ER, so I advocate for talking to our doctors about this exact thing - what kinds of strategies can we employ at home when the going gets extra tough and we are out of treatment options. I was talking with a friend who suggested scheduling a massage therapy appointment or two during this window to try to keep my neck from getting tight while waiting for my next botox treatment. I like that idea as a preventative. Thanks again for sharing your insights- very thought-provoking! Warmly - Holly (team member)
azreynolds Member
Yes, it seems mine (Aimovig and botox) isn't working as well. They've ordered an MRI since my symptoms are changing. It could be from the faceplant I had last year, June 2023. I guess there's no way to really know. They added Nurtec which helps sometimes, and I was told last week to add half of a sumatriptan if nothing happens in 2 hours. I'm testing out Weather X ear plugs too. One day they helped, the next they didn't. Isn't that the way it goes? Hope you all are well. 
1. azreynolds Member
 <inline-mention username="Holly Harding" user-id="3755969"/> Oh, I am so sorry to hear that Quilpta suddenly stopped working! Geez, doesn't feel like when they come back, it feels much much worse?! I'm fighting one right now that I woke up with. Life in the fast lane, huh? Gentle hugs and hoping you're doing better than me. Lol.
2. Holly Harding Moderator & Contributor
 <inline-mention username="azreynolds" user-id="3677307"/> Yes! It DOES feel worse when they come roaring back after we experience any kind of a break in frequency or severity. It's amazing how quickly we forget how horrific the daily slog of chronic migraine can be. I'm so sorry you've got one on currently, my dear. I hope you experience some relief from the severity soon. I've been fighting one back all day - just finally took a phenergan, so.... nightynight! 🤣. I know that med doesn't make you sleepy. THAT makes me so jealous. Ha.. yes! Life in the fast lane. I can't imagine anything slower than this. Love you. Warmly - Holly (team member)
Tonya Henry Moderator & Contributor
<inline-mention username="Holly Harding" user-id="3755969"/> I am currently just using Aimovig 140 mg monthly. I do still get migraines and use my nasal sumatriptan when needed. When this does not work, I add Excedrin. If this fails, I go to Meloxicam or Zanaflex. My provider actually said Zanaflex and Phenergan can be used to treat migraines. That was a shock to me. At last resort, I will add Phenergan (liquid). I have issues with oral medications so I try not to take them. I never know if they will be absorbed properly or not. Hope you are well tonight and symptom-free!! (Tonya, team member).
1. Holly Harding Moderator & Contributor
 <inline-mention username="kateymac" user-id="3784217"/> Oh wow! That's fascinating. I wanted to chime in on this because when I went to the ER for migraine treatment, they gave me "the migraine cocktail" which was an IV that included magnesium, benedryl, phenergan, and then a shot of toradol. Like you, I got very squirrely and felt like I was going to have to tear the IV out of my arm. Restless leg all over the body is the perfect description! I've never felt that way before and I've had everything in that IV before except the benedryl. I asked them why I was having that reaction and they said there was no reason I'd be feeling like that. In fact, they said I should've been feeling sleepy. Later, when I saw my migraine specialist and told him what happened, he told me it was 100% the benedryl. He said that some people have the opposite reaction to medications than that which is well-known. I similarly get weirdly jazzed up when I take opioids. So, he concluded I'm one of "those" people. What I hate is the feeling of not being heard by our healthcare providers when we are clear about how we are feeling! Very frustrating. Hope you're faring alright, Katey. Good to hear from you, as always. Warmly - Holly (team member) 
2. Tonya Henry Moderator & Contributor
 <inline-mention username="kateymac" user-id="3784217"/> oh no! I am so sorry. I can definitely relate, not just to the reaction, but those "crickets," when sometimes explaining to drs. Luckily it was my allergist/immunologist who prescribed this med for me. I do have Mast Cell Activation Syndrome and commonly react to too many things. It keeps things interest for sure. I hope you are doing better now. (Tonya, team member).
azreynolds Member
<inline-mention username="Tonya Henry" user-id="4506979"/> I use Phenergan as a pain med sometimes too. It has a pain fighting ability, but it's not great. It only seems to help if you take it immediately upon sensing your nausea. But if you're at a full blown migraine, it's like spitting in the ocean. My sumatriptan is regular pill form. I've been on Aimovig 3 years, in the middle of my 4th. Botox started just 3 months later. Since I've had migraines for 63 years, my neurologist requested I give these medications at least 2 years before I gave up on them. They were working before the June fall and my cataract surgery. I was at 24-28 days per month. I dropped 4-5 days! Then in 2021, I got sclera contacts binasal occlusion glasses to help correct the visual complications from my TBI, and I went from 20-22 days down to 7-10!! Man, that was awesome! But my cataract surgery in the spring of 2023 wasn't successful like everyone else talks about. I can only see colors and semi-blurry double vision shapes in my left eye, resulting in migraines inching back up. Then I fell June 2023, and I'm back to 18-22 days per month....but they're still not as severe as they were when I was working.
1. Holly Harding Moderator & Contributor
 <inline-mention username="azreynolds" user-id="3677307"/> You have so many ingredients in your migraine soup, my dear! So many variables you are juggling. It is that awful game of whackamole- when you get a handle on one thing, another pops up that requires your attention. Each condition is demanding in itself - and each medication has its own demands with side effects and interactions with other meds. It's more than a full-time job to juggle and manage it all. You are a warrior, my dear. An incredible inspiring woman who keeps going - learning lessons, earning wisdom - and sharing what you're learning with the rest of us. We are here for you and so grateful to you. Warmly - Holly (team member) 
2. Tonya Henry Moderator & Contributor
 <inline-mention username="azreynolds" user-id="3677307"/> oh my!! Wow. You have been through a lot with your migraine history. I am so sorry the surgery was not effective. We try things to improve our lives/conditions, but it sometimes, makes things worse. I have been doing pretty good with my Aimovig/sumatriptan combo. The last few months, I believe my eye sight is changing. Either need bifocals or my eyes are getting worse. Know you are not the only one in which eye surgery caused an unwanted side effect. I wanted to share this forum with you: https://migraine.com/forums/aura-plus-speech-and-smell My nephew had cancerous tumor removed from one eye and biopsy done on the other. After this, he started having migraines. I am sure he still prefers this over the lymphoma removed from his eye though. I hope that tonight you are able to sleep without symptoms. (Tonya, team member).
Prettymomma Member
Yes, I have had this issue in the past. I have had Occipital Nerve Blocks, Botox, and all of the meds in the CGRP group, but I have never just had those alone. I have always had Gabapentin along with a huge variety of migraine medications that I have taken over the years. I definitely could tell by the severity of the migraines when the medications that last longer would wear off. Never did they ever take me close to when my next dose would be. What did I do in the meantime... Not much I could do. I was already taking everything that I could. I no longer take any of the nerve blocks, botox, or CGRP because they just stopped helping altogether. Right now I take Nurtec every other day. I still have a migraine every day, but it does help with the severity of them. 😀
1. Prettymomma Member
 <inline-mention username="Tonya Henry" user-id="4506979"/>, Wow we have a lot in common. Fortunately I am able to swallow my pills for the most part, though I do have days where it is hard to swallow. I am so sorry that you are going through this. Isn't it crazy how much wiggle room in the dosage of Gabapentin. I too have had multiple levels of the medication. I am curious how you did going off of Gabapentin altogether. I have had days where I forget to take my pills and without it my body is in a complete uproar in pain and extreme nerve sensitivity. To the point where I would get grouchy and my family would say " Mom, did you take your pills?" Then I would go and look and see that I didn't and after taking them all of a sudden I would turn into a happy lady that was nice to live with again😀 So, for me this is a must because it helps so much with pain and the nerve sensitivity, otherwise I am jumpy, my headache is through the roof, and my skin is so sensitive that if someone touches me even lightly it hurts... Weird but true. Anyway, thank you for your comment! Take care😀 
2. Tonya Henry Moderator & Contributor
 <inline-mention username="Prettymomma" user-id="7002652"/> I am doing ok without it. I do have Meloxicam if needed, and, hydroxycloroquine. The side effects were not worth continuing. I do sometimes still get the burning nerve pain. I'm glad to hear it helps you so much. Hang in there and hopefully it'll continue to help for years to come! (Tonya, team members).
Prettymomma Member
It was pretty easy to take the leap. The other medications were not working for me anymore. Nurtec helps keep the severity of them down for the most part. I still live with a debilitating headache all day every day, but so far this has helped. I have had episodes that are bad where I can't walk, and I can't talk without stuttering or even make a sentence, and I have had these episodes while taking Nurtec but it has been a little more under my control and I just go to bed, whereas with the other medications they were not able to keep me out of the hospital and having to get an infusion. I am fearful though, that after a while it will no longer help me just like the other ones have done, or that my insurance will stop covering it. I know that is not a very positive thing to say, but I am just being real. Anyway, that is where I am at right now.😀
1. Prettymomma Member
 <inline-mention username="Holly Harding" user-id="3755969"/> , love the imagery of the lab rat and scientist! That is a perfect picture! It is also good to know that I am not the only one that has experienced medication not being helpful over time. I too, am grateful for this site and the support that is here for all of us. Sometimes when I am not even able to type a sentence and I am in pain and feeling down, I look at some of the wonderful things people have said to me here, or even just seeing people that are going through the same things or even harder things too, and the inspiration that they give me! You are one of them! Thank you for all you do!😀
2. Holly Harding Moderator & Contributor
 <inline-mention username="Prettymomma" user-id="7002652"/> I'm so glad to hear how our site gives comfort when you are struggling. Thank you for your very kind words, my dear. I feel the absolute same way about you. I light up when I see your name. All love to you. Warmly - Holly (team member)