what should you do when migraines don't respond to treatment

• Turn off the lights. Migraines often increase sensitivity to light and sound. Relax in a dark, quiet room. Sleep if you can.
• Try temperature therapy. Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the sensation of pain. ...
• Drink a caffeinated beverage. In small amounts, caffeine alone can relieve migraine pain in the early stages or enhance the pain-reducing effects of acetaminophen (Tylenol, others) and aspirin. ...

How can I Manage my migraines without medication?

Deep breathing from your diaphragm can help you relax. Focus on inhaling and exhaling slowly and deeply for at least 10 minutes every day. It may also help to consciously relax your muscles, one group at a time. When you're done, sit quietly for a minute or two. A diary may help you determine what triggers your migraines.

Can you stop migraines before they start?

Migraines cause pain as real as the pain of injuries — with one difference: Healthy habits and simple nonmedical remedies sometimes stop migraines before they start. Medication is a proven way to treat — and prevent — migraines. But medication is only part of the story.

Is there hope for those living with migraine?

While it can be extremely frustrating to try one treatment after the next, there is hope for those living with migraine to find relief. Dr. Richard Lipton is Director of the Montefiore Headache Center and Neurologist at the Albert Einstein College of Medicine.

What are the treatment options for status migrainosus?

If someone presents at the ER with migraine and has not been prescribed a triptan, the first option is usually to administer a subcutaneous injection of sumatriptan. Toradol (ketorolac) is most often used in the ER to treat Status Migrainosus. There are numerous studies to support its effectiveness, which can be as high as 80%.

What do you do when a migraine medication doesn't work?

If your OTC medicines haven't worked, your doctor may prescribe stronger medications called triptans, including:Almotriptan (Axert)Eletriptan (Relpax)Frovatriptan (Frova)Naratriptan (Amerge)Rizatriptan (Maxalt)Sumatriptan (Imitrex)Zolmitriptan (Zomig)

Why won't my migraine go away even with medication?

The most common trigger that makes patients difficult to treat is medication overuse. A patient who is taking an over-the-counter medication that contains caffeine on a daily basis, may not get better. The very medicine they take to relieve their pain triggers their next headache as it wears off.

What to do for migraines that won't go away?

See a doctor for a headache that never goes away, and for a constant headache that keeps occurring in the same area of the head. People should seek immediate medical attention if they experience the following: a sudden, severe headache.

What happens if triptans don't work?

What do you do if you take a triptan and it doesn't work? If you wait two hours and your triptan's still not working, you might have to use another acute treatment (like an NSAID) for that attack. You could also try heading to a dark, quiet room and using home remedies to help relieve the pain.

When should you go to the ER for a migraine?

Go to the ER if you are experiencing severe migraine symptoms, or symptoms such as confusion, fever and vision changes, neck stiffness, trouble speaking or numbness or weakness, even if other symptoms of migraine are present (e.g. light sensitivity, nausea).

What is the strongest migraine medicine?

Triptans. Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine.

How long is too long for a migraine?

How long is too long? If a migraine headache lasts longer than 72 hours without responding to regular migraine medication, the person may need additional treatment. Anyone who has experienced this pain for longer than 3 days should speak with a doctor as soon as they can.

What does a brain tumor headache feel like?

For most individuals, a brain tumor headache is localized to a specific area and is typically worse in the early morning or at night. They can be dull, pressure-like headaches that are made worse by coughing or sneezing. Over time, these headaches stop responding to over-the-counter medication.

Why are my migraines getting worse?

There are a number of migraine triggers, including: Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women. Hormonal medications, such as oral contraceptives, also can worsen migraines.

What does it mean if sumatriptan does not work?

Headaches that are not relieved by sumatriptan are sometimes caused by conditions that need other treatment. If you feel much better after a dose of sumatriptan, but your headache comes back or gets worse after a while, wait at least 2 hours before taking another dose.

What can I take if sumatriptan does not work?

The 30 or 40 % of patients that do not respond to one triptan may well respond to one of the other triptans. ¹ Eletriptan has been found in one study to be effective in patients who found oral sumatriptan to be poorly effective or to cause side effects.

Can triptans make migraines worse?

A number of drugs, including triptans, promote migraine chronification in susceptible individuals.

How to stop migraines?

However, at that point, the digestive system may be totally paralyzed, and the medication just sits in their stomach until the attack is over—a reason to try non-oral options such as a nasal spray or injection. “I know patients strongly prefer oral treatment,” Lipton said, “but if your digestion system is paralyzed or if you experience nausea and vomiting, you just need to find another way to get the medication in.” And often, he said, the medicine a patient uses to acutely (as-needed or on-demand) treat a migraine is actually the source of the problem. “A patient who is taking an over-the-counter medication that contains caffeine to treat their migraine on a daily basis may not get better,” he said. “The very medicine they take to relieve their pain triggers the next headache.”

What happens when migraine treatment fails?

When a migraine treatment strategy fails, your options are far from limited. In the same way that everyone experiences migraine differently, not every treatment plan works for every person.

How much does Lipton recommend for headaches?

Instead, Lipton said, a reasonable goal for treatment is to decrease a person’s headache days by 50% or 75% or reducing the intensity of the headaches by 50%-75% and allowing acute medications to work faster and more effectively. This will “minimize the time that headache is interfering with ability to function.”.

What is treatment failure?

Treatment failure is often a product of miscommunication and misunderstanding, perhaps about a person’s symptoms or about what someone actually needs to treat their specific type of migraine. In other words, it may not actually be a failure at all.

Can caffeine help with migraines?

“A patient who is taking an over-the-counter medication that contains caffeine to treat their migraine on a daily basis may not get better,” he said.

Is Botox approved for episodic migraine?

“The subtype matters,” Lipton said, “because the treatment needs to match the subtype of migraine.” If your diagnosis is chronic migraine, OnabotulinumtoxinA (Botox®) is effective, but it is not approved for use if your diagnosis is episodic migraine. People can read about the characteristics of various headaches, he said, and then confirm that the diagnosis they were given corresponds to their experience.

What is the persistence of migraines?

The persistence of chronic migraine can be quite disheartening, causing patients who have tried multiple treatments with no results to feel that they are out of options. Richard B. Lipton, MD, FAHS, Director of the Montefiore Headache Center, Professor of Neurology at the Albert Einstein College of Medicine, and past president of the American Headache Society has treated numerous patients with this concern. Over the years, he has developed a strong grasp on when to move forward with a possibly effective treatment plan and when to change course. In an interview with the American Headache Society, Dr. Lipton explains how he chooses his treatment methods and offers advice to others treating persistent migraine.

Why is it important to stress that preventive drugs need time to work?

It’s important to stress that preventive drugs need time to work because the word ‘prevention’ itself creates unrealistic expectations for patients. They may assume that as soon as they take the drug, they’ll never have another headache. The reality is that for oral preventives, benefits develop slowly.

What triggers migraines?

Be Mindful of Migraine Triggers. Many migraine patients can identify specific things — stress, sleep irregularities, hormones, diet, alcohol, light, and smells are common culprits — that make it more likely for them to experience a migraine attack.

Why do people take only acute medication?

“Some patients take only acute medication because they don’t want to be on preventative medication, ” for instance, due to potential side effects, says Dr. Diamond.

Can you take a migraine med late?

If you take the medication late, its effect may not kick in at all, or may kick in partially, but the head pain and other symptoms can remain. “That means you have to re-dose, which in turn can lower your threshold for your next migraine attack,” says Dr. Diamond.

Do people stay on preventive medication?

In other words, sometimes people stay on preventive medication even though they may not actually be helping them anymore. The upshot, he says: “It’s always good to have regular discussion with your health care provider to ensure that the efficacy has remained good and that the medication remains necessary.”.

Does caffeine help with migraines?

According to the American Migraine Foundation, because caffeine can trigger a migraine attack, taking an over-the-counter NSAID that contains caffeine can both not help your current headache and trigger another.

Why are migraines so difficult to treat?

Migraines can become transformed and difficult to treat if a person has a history of treatment-responsive migraines but then experiences a psychological problem. The transformer, for example, could be a divorce, death of a loved one or anxiety.

How many migraines are resolved with one triptan?

If only one oral triptan is used then, at best only 60-70% of migraines will be resolved. The remaining 30-40% will then be labeled “triptan unresponsive,” when in fact, the migraine responds to a different triptan or to the nasal spray or injection form.

What is transformation migraine?

Transformed migraine initially has a typical migraine presentation. The migraines have an obvious start and finish with discrete headache-free periods between attacks. Gradually the headaches increase in duration with fewer and fewer pain-free days. The use of analgesics may increase over time with less and less response. The etiology of transformation may be time, under-treatment, or a comorbid condition. Transformed migraine can be sub-classified as pseudo-transformed, rebound, or psychological and are discussed in the following sections.

What is the difference between a transformed psychological migraine and a migraine caused by psychological issues?

The difference between a transformed psychological migraine and a migraine caused by psychological issues is the timing of the migraines and the psychological issue. In transformed migraines, treatment-responsive migraines were present prior to a new psychological issue.

What is rebound migraine?

It can occur with any type of analgesic and can even occur with triptans. Rebound is actually a form of withdrawal syndrome characterized by excess or uncontrolled central nerve transmission. 6 A common example is butalbital.It may only lessen the pain without treating the underlying condition of 5HT binding site activation. Initially butalbital may be required several times per month progressing to several times per week, then to daily use and quickly progressing to multiple doses per day. Use can escalate to as much as six, eight or even twenty doses per day. The concern is heightened considering that 4gm of acetominophen a day can be a hepatotoxic dose. As infrequently as 2-3 doses per week can cause rebound in a susceptible individual.

Can triptans cause migraines?

While triptans are the best treatment for migraines, they are sometimes not used in the correct fashion. For instance, frequently a patient single doses triptans and does not know that he or she can take a second dose in the same day. The patient may be so happy that the migraine was partially relieved by the first triptan that a second dose is not taken because (1) the patient does not know he or she can, (2) cost issues, (3) side effect issues, or (4) he or she is simply happy with a 50-75% improvement in the pain. However, 87% of patients desire to be pain-free. 3

Is migraine a benign condition?

Not all treatment-responsive migraines are benign. Other conditions to consider are temporal arteritis, muscle-tension headache, other complicating factors, or even a brain disorder. Temporal arteritis is easily mistaken for migraines. Diagnosis is made with biopsy and a sedimentation rate.

How to stop migraines?

Small tweaks in your daily routine can lower the number of headaches or migraines you have: 1 Drink plenty of water. 2 Don’t skip meals. 3 Watch your caffeine intake. 4 Limit alcohol. 5 Manage other health problems. Conditions like anxiety or high blood pressure can trigger headaches if you don’t keep them under control. 6 Watch your use of medicines. Taking OTC pain relievers too often, or at a higher dose than advised, could cause more problems. Once the drug wears off, withdrawal symptoms start. This leads to more head pain and the need for more medicine. Doctors call this a rebound headache. 7 Stick to a sleep schedule. Too little or too much rest can trigger headaches. 8 Get to a healthy weight. A high body mass index (BMI) can lead to more migraines. 9 Track your headaches. Write down when you get one and what you were doing right before. Make sure to include what, if anything, helped ease your pain.

How to get rid of headaches?

Stick to a sleep schedule. Too little or too much rest can trigger headaches. Get to a healthy weight. A high body mass index (BMI) can lead to more migraines. Track your headaches. Write down when you get one and what you were doing right before. Make sure to include what, if anything, helped ease your pain.

How to treat cluster headaches?

Immediate treatment: Some drugs can put a quick end to a headache or migraine. Your doctor might have you inhale oxygen through a mask to relieve cluster headaches. Doctors might refer to this type of treatment as abortive therapy. Ibuprofen or naproxen may relieve migraines or tension headaches.

What kind of doctor can help with headaches?

Your primary care doctor is a good starting point, but headaches are complex. Neurologists and headache specialists have special training to help them figure out the type of headache you have and its causes. They can come up with a treatment plan to manage your symptoms.

Can you get headaches after another?

If you get one headache or migraine after another and over-the-counter (OTC) pain relief doesn’t help, you do have options. Headaches are tricky. Most of the time, there isn’t a single cause. They result from many different things going on inside and around you.

Does a headache go away?

Your headaches are severe or come on quickly. Your headache never fully goes away. You take pain relievers more than twice a week. You take a higher dose of medicine than what’s advised on the label. Actions like bending over, coughing, sneezing, or having sex bring on a headache or migraine.

Can triptans help migraines?

But, for more severe migraines, prescription triptans are often recommended. Preventive treatment: Prescription drugs can stop pain before it starts. It can make what you do feel less severe. Nondrug treatments: Many natural therapies can be useful, too. Your headache specialist may suggest:

Why can't I take preventive migraine medicine?

Many patients don’t tolerate preventive migraine therapies because of side effects, which can lead them to stop taking those meds, says Sacco.

What does it mean when a migraine doesn't work?

If many different types of medications don’t work for you, it could mean you have resistant or refractory migraine. Individuals who don’t get adequate pain relief from existing abortive and preventive treatments can be classified as having resistant or refractory migraine, according to Sacco.

How to determine if migraine is resistant?

Resistant migraine is determined by the number of preventive migraine treatments that have failed — at least three classes — as well as the number of debilitating headache days a person has — at least eight per month for at least three consecutive months without improvement.

What to do if you have nausea?

If You Have Nausea, Consider a Non-Oral Medication. How a drug is delivered may impact how effective it is in treating a migraine attack, says Sacco. Some people have early nausea with attacks, which can be an indication that there’s some impairment in how the gut is working, she says.

How long does it take for a migraine to start working?

“Preventive migraine medications such as beta-blockers and antidepressants may take at least 15 to 20 days to start working and then peak around three months,” he says.

Is it okay to take less than the recommended dose?

Make Sure You’re Taking the Recommended Dose. Sometimes drug failure can be a result of a person taking less than the recommended dose, says Sacco. “There are some patients who tend to take lower than recommended doses,” she says. “This is not good.”.

Can you take triptans for migraines?

Don’t Wait Too Long to Take Abortive Migraine Medication. Triptans are one of the most commonly used abortive therapies in migraine treatment, unless people have specific health conditions where it might be contraindicated, says Rajneesh.

How to get rid of migraines?

When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead or at the back of your neck.

What is the best way to diagnose migraines?

Diagnosis. If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination. If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes ...

What are the two types of medications used to treat migraines?

Medications used to combat migraines fall into two broad categories: Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms. Preventive medications.

What medications can help with migraines?

Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, InnoPran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Verelan) can be helpful in preventing migraines with aura. Antidepressants .

Does Lasmiditan cause headaches?

This newer oral tablet is approved for the treatment of migraine with or without aura. In drug trials, lasmiditan significantly improved headache pain. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours.

Can caffeine cause migraines?

When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract. Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain. Triptans.

Does acupuncture help with headaches?

Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. Biofeedback. Biofeedback appears to be effective in relieving migraine pain.

What is the first step in treating status migraine?

In most ERs, the first step in treating Status Migrainosus is IV fluids to correct any dehydration that may be present, especially if the patient has been vomiting.

How long does it take for a migraine to go away?

In fact, a meta-analysis of existing studies showed that migraine often recurred 24-72 hours after discharge when corticosteroids were used.

What is a rescue treatment?

A rescue treatment should be a medicine that you can administer at home when your abortives fail.

What is the best medicine to abort a migraine?

A rescue treatment is different than the typical medicine you use to abort a migraine. Most often, patients are prescribed a triptan, NSAID, or ergot-derivative to abort a migraine attack. These are acute medications that can be used at the first sign of symptoms. When these treatments fail, it is appropriate to use a rescue treatment.

Is chlorpromazine a pretreatment?

They all have the risk of causing temporary dystonia or akathisia. Diphenhydramine is often used as a pretreatment to prevent these side effects. Chlorpromazine (Thorazine) is an older medicine with a long history of effectively breaking status migrainosus. Prochloroperazine (Compazine) is more commonly used in children.

Can opioids cause migraines?

Opioids. While generally avoided when treating migraine, opioids are occasionally used to break intractable pain. They are not as effective as other treatments. When used long term, they can contribute to the development of chronic migraine and medication overuse headache.

How to avoid migraines?

Your eating habits can influence your migraines. Consider the basics: 1 Be consistent. Eat at about the same time every day. 2 Don't skip meals. Fasting increases the risk of migraines. 3 Keep a food journal. Keeping track of the foods you eat and when you experience migraines can help identify potential food triggers. 4 Avoid foods that trigger migraines. If you suspect that a certain food — such as aged cheese, chocolate, caffeine or alcohol — is triggering your migraines, eliminate it from your diet to see what happens.

How to relieve migraine pain?

Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect. Drink a caffeinated beverage. In small amounts, caffeine alone can relieve migraine pain in the early stages or enhance the pain-reducing effects of acetaminophen (Tylenol, others) and aspirin. Be careful, however.

How to stop migraines from numbing?

Turn off the lights. Migraines often increase sensitivity to light and sound. Relax in a dark, quiet room . Sleep if you can. Try temperature therapy. Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the sensation of pain.

What to do when you can't fall asleep?

The harder you try to sleep, the more awake you'll feel. If you can't fall asleep, read or do another quiet activity until you become drowsy. Check your medications. Medications that contain caffeine or other stimulants — including some medications to treat migraines — may interfere with sleep.

How to relax your diaphragm?

Deep breathing from your diaphragm can help you relax. Focus on inhaling and exhaling slowly and deeply for at least 10 minutes every day. It may also help to consciously relax your muscles, one group at a time. When you're done, sit quietly for a minute or two.

How to get better sleep?

Unwind at the end of the day. Anything that helps you relax can promote better sleep: listen to soothing music, soak in a warm bath or read a favorite book. But watch what you eat and drink before bedtime. Intense exercise, heavy meals, caffeine, nicotine and alcohol can interfere with sleep. Minimize distractions.

Does exercise make migraines worse?

These chemicals also help alleviate anxiety and depression — and these two conditions can make migraines worse. Obesity also increases the risk of chronic headaches. Maintaining a healthy weight through exercise and diet can provide additional benefits in managing migraines.