5 Things to Consider If Your Acute Migraine Medications Are Not Helping

It can be frustrating and painful when your acute migraine medications don’t ease your symptoms. Here are five questions to ask yourself, and your doctor, to help figure out why you aren’t getting relief.

Migraine treatment is broadly split into two categories: preventive and acute treatments. Preventive treatment aims to reduce the frequency and intensity of migraine attacks over time.

Acute treatment, on the other hand, works by aborting an incoming or active migraine attack. Those who experience the occasional migraine attack will probably find acute medication sufficient.

Some common acute migraine medications include:

• over-the-counter (OTC) painkillers
• triptans
• antinausea drugs
• opioids
• ergotamines
• calcitonin gene-related peptide (CGRP) antagonists like Ubrelvy, Qulipta, and Nurtec ODT

If you experience more than four migraine attack days a month, you may want to consider both preventive and acute treatment options to help you manage migraine effectively.

If you live with migraine, you may be familiar with the frustration and stress of taking acute medication and not finding relief. Effective acute medication should provide pain relief or pain freedom within 2 hours. Here are five things to consider if more than 2 hours have passed and your pain has not lessened.

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How frequently are you taking acute medication?

The first thing to consider is the frequency of your acute medication. How often are you taking pain medication for migraine?

It can be really helpful to record in a diary the total number of days that you take acute medication for migraine. It’s recommended not to use medications like triptans, ergotamines, or opioids for more than 9 days of the month, or more than 2 times a week though it varies depending on the medication used.

Other painkillers like NSAIDs and acetaminophen should be limited to 15 days a month.

Taking acute medication too frequently can result in medication overuse headaches or your treatment becoming less effective over time. If you are taking acute medication increasingly frequently, it’s important to speak with your doctor. They will be able to let you know how often it is safe to take your acute medications. They can also help you find alternative treatment options.

Are you taking acute medications at the right time?

The timing of when you take your acute medication for migraine may also be to blame for the lack of relief. Time really is of the essence when it comes to treating a migraine attack effectively.

The earlier you can treat an attack and stop it in its tracks, the better. If you’re like me, you may be prone to waiting until the attack is well underway (with vomiting and a pounding head) before deciding to reach for your acute medication.

To really get on top of attacks early we must play detective and try to recognize our earliest prodrome symptoms of an attack. Prodrome symptoms can serve as a warning and may include a sudden change in mood such as feeling irritable or euphoric, excessive yawning, and needing to urinate more often. For those who have migraine with aura, the aura stage often serves as a clear indication an attack is underway and acute medication should be taken.

Prodrome symptoms can be hard to spot, and treating attacks as soon as you notice these early warning symptoms is a fine art, as they can vary from attack to attack. Because I can’t take my acute medications all the time, I often feel I don’t want to “waste” a medication day unless I’m sure I’m having a migraine attack.

Are you taking the correct dose of your acute medication?

The dose of your acute medication is another important factor to consider if you’re not getting relief.

Headache specialists often prescribe much higher doses of NSAIDs to those with migraine than a primary care doctor would. Similarly, many people with migraine aren’t aware that there are different doses available for some acute medications like triptans.

It’s important to discuss dosing with your doctor and explore the different combinations of acute medications, such as an NSAID paired with a triptan. The medication you’re on might be effective for you if it’s taken at a different dose.

Could gastric stasis be to blame?

Gastric stasis could be keeping your acute medication from providing you relief. During a migraine attack, your stomach empties more slowly than usual. It’s thought that this is one of the reasons migraine attacks cause many people to feel nauseous and vomit.

One of the biggest problems of gastric stasis is that it makes it very difficult for your acute medication to be absorbed properly. Antiemetics, medications that stop nausea, can be helpful if this is something you are navigating. Some doctors will advise taking these shortly before taking triptans and other acute medication.

If you’re having difficulty keeping medication down, it’s worth exploring non-oral methods of delivering the medication. For example, some of the triptans are available as an injection or nasal spray. CGRP inhibitor medications can also be available as injections.

Is it time to try something new?

Once you have addressed the frequency, timing, dose, and gastric stasis issues involved with acute medication, it’s worth considering drug-free options, too. One such alternative that has helped me is a neuromodulation device. These devices can be an alternative or addition to acute medication for migraine. Neuromodulation devices are believed to be safe to use and some have been approved by the Food and Drug Administration (FDA.

Some devices work purely as an acute treatment, like Nerivio. Others, such as the Cefaly and gammaCore, have settings aimed at both preventive and acute treatment. These are great options to talk with your doctor about if you still aren’t finding relief from your acute medications, or you’re finding that you need to take your acute medications more often than recommended.

The bottom line

Navigating the world of migraine therapies and treatments can feel overwhelming. It can also feel frustrating when a treatment doesn’t work as expected. No matter what you are going through, connecting with others who understand how you feel is helpful.

The Bezzy Migraine community’s Medication and Treatments forum is a great place to share stories and learn from others who get what you are going through.