7 Signs You Need to Reevaluate Your Migraine Treatment Plan
How to Respond When Migraine Relief Falls Short
A well-rounded plan treats attacks quickly and helps prevent future episodes. Knowing your options helps you work with your doctor to adjust treatment for more relief.
Whether you experience chronic migraine or occasional attacks, having a clear migraine action plan is essential for managing this condition. The plan, created along with your doctor, should be your go-to guide for finding relief. It generally includes details on your individual:
Headache and migraine attack history
Rescue (acute) therapies to use during an attack
Preventive treatments
Lifestyle strategies
Guidance on when to seek emergency care
Migraine attacks are unpredictable, though, and even the best plan may need adjustments over time. Here are some telltale signs your migraine treatment plan could use some attention.
“That tells me we need to take a closer look at your preventive therapy plan,” says Nicole Caunt, DO, an assistant professor of neurology and headache medicine specialist at the University of Colorado School of Medicine in Aurora. “We may need to start preventive therapy or adjust the dose, change the approach, or add a new medication.”
With so many types of preventive treatments, including antidepressants, antihypertensives, and even anti-seizure medications, it’s important to work with your migraine specialist to determine the most effective option for you.
2. Longer or More Severe Attacks
If migraines are lasting several days or getting more intense, it’s time to consult your doctor.
“Oftentimes, you need to consider whether changes should be made to your preventive therapy, because that’s what it should be doing: reducing attack frequency, intensity, and duration,” says Dr. Caunt.
In these cases, your doctor may also recommend new imaging tests, says Caunt, to rule out any other factors that could be triggering these longer, more intense migraine attacks.
3. More Breakthrough Attacks
If you suddenly start having breakthrough attacks, despite being diligent with preventive treatments and lifestyle changes, it’s a sign to review your treatment plan. Your doctor may ask to take a look at your diary — a detailed log of each headache and migraine attack. You should include notes on the duration, frequency, and severity of each attack, as well as any symptoms and potential triggers. This helps guide the next steps in your care.
“If it’s related to bright sun, we might recommend wearing sunglasses to reduce exposure,” says Caunt. “But if it’s related to barometric pressure changes, then we’re dialing in on lifestyle changes like maintaining a healthy diet, exercising, prioritizing sleep, staying hydrated, and making sure stress is under control.”
4. Less Effect From Acute or Preventive Treatments
Occasionally, migraine treatments may start to feel less effective. This is rarely due to tolerance, which Caunt notes doesn’t generally develop with migraine medications. Instead, it may be related to miscommunications about symptoms or unrealistic expectations around treatment results (for example, believing migraine will disappear overnight).
That said, if treatment seems less effective than it used to be, your doctor can help adjust the plan. “Sometimes, we will change the medication. If there’s room to increase the dose, we can do that,” says Caunt. “And other times, we may add a new medication to try to better control migraine.”
5. Greater Impact on Daily Life
Migraine attacks can cause you to miss out on work or school, social gatherings, or hobbies. Over time, these disruptions can take a toll on your mental health. A well-designed treatment plan should help you maintain your usual routine with minimal disruption. If migraine is causing anxiety or depression, it’s a good idea to revisit the treatment plan.
6. Side Effects and Difficulty Sticking With Current Treatments
In some cases, migraine medications may cause unpleasant side effects, or you may struggle to keep up with the treatment regimen. These types of factors can make the plan less effective.
“Fortunately, there are many different options,” says Caunt. “For example, monthly injectables can be a good alternative for people who struggle to take a daily medication.”
Or, if a medication causes drowsiness, your doctor might suggest taking it at night, which can also help improve your sleep when you need it most.
7. Overuse of Medication
Relying on rescue meds more often is another sign to review the treatment plan with your doctor. Overusing these drugs may lead to a medication overuse headache, also known as a rebound headache.
Signs of a rebound headache include:
Daily headaches
Irritability
Memory problems
Nausea
Restlessness
Trouble concentrating
And while these symptoms may temporarily improve after taking acute pain medication, they’ll often return once the medication wears off.
If you notice these patterns, speak to your doctor to determine whether adjustments to the dosages, a change in medication types, or alternative treatments are needed.
The Takeaway
When you live with migraine, it’s important to recognize warning signs that your migraine action plan may need updating.
Keep a detailed log of each migraine attack to detect if there’s been an increase in frequency, length, or symptom strength or if you’re experiencing breakthrough migraine attacks.
Your doctor can use this information to adjust your treatment plan by changing your medications, adjusting dosages, adding new therapies, or recommending lifestyle changes to improve your overall quality of life with migraine.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Dr. Michael Yang is a neurologist and headache specialist at Emplify Health, and an adjunct professor of neurology at the University of Wisconsin Madison School of Medicine.
He completed his residency in neurology at University Hospitals Case Medical Center in Cleveland, and went on to complete a headache fellowship at Dartmouth Hitchcock Medical Center in New Hampshire. He is certified in headache medicine by the United Council for Neurologic Subspecialties.
Priscilla Blossom is an independent journalist, essayist, and writer who wears many other hats. She specializes in the intersections of health and wellness; family and relationships; travel, arts, and culture; and lifestyle and identity. Her health writing has appeared in outlets like The New York Times, Washington Post, Yahoo Life, Glamour, Parents, HealthCentral, Oprah Daily, Romper, LGBTQ Nation, and many others. She is a mental health advocate, particularly for queer and Latine folks and those living with anxiety, depression, post-traumatic stress disorder, and grief.
