Breakthrough Migraines: A Gray Cloud to the Silver Lining

When you hear the term "breakthrough" you usually think of good things: "Scientists announce a breakthrough in the fight against ..." whatever it is scientists happen to be fighting against. When it comes to migraine prevention, however, a breakthrough isn't necessarily so benign.

Open up the medicine cabinet in our house and plow through the various beauty accoutrements that my wife has (what exactly is a loofah for, anyway?), and you'll find two kinds of migraine medicines there: preventatives and abortives. The abortives are the ones that I take when I have a migraine coming on (or it is already there), and in my house they have names like Maxalt, Midrin, and Ibuprofen. The other kind is a preventative. These are the ones I take every day to try to keep the migraines from coming back. I've tried a lot of different ones, with different degrees of success. The one I'm on right now (and with the greatest degree of success) is an anti-seizure medicine called Topamax.

The absolute ideal of a migraine preventative is that it will prevent the recurrence of a migraine. My neurologist tempered my enthusiasm, however, and told me to expect (or maybe "hope" was the word that he used) the preventatives would reduce the frequency and-- possibly-- the severity of the migraines. For the migraines that did occur, I should fall back to my trusty abortive medications to take care of them. These migraines that broke through the preventative medicine shield were aptly named "breakthrough" migraines.

For the record, he was right. For me, Topamax was the right combination of successful prevention and tolerable side-effects. I don't have one hundred percent success with Topamax, but I also don't have the migraines daily, and when they do come, they usually peak at a Richter three or four, instead of a screaming eight.

When you have frequent migraines, you start to build up a tolerance to the lower level ones that you don't even realize. Sure they hurt, and they really do sour your outlook on life - don't get me wrong on that - but once you get on to a preventative that cuts out the headaches for a while and gets you pain-free for a bit, all of the sudden you realize everything you've been missing. The days seem sunnier, and people (particularly *you*) seem nicer.

Then the breakthroughs come, and it's like a gloomy morning on the day you had the picnic planned. If you're lucky, it's a single breakthrough, you pop an abortive, and you're back in business. If you're unlucky, though, you're in a cycle. For some reason your triggers are ringing your migraine bell over and over and over again. Maybe not really hard, but hard enough to get your attention.

That's where I am right now- an almost constant headache. Usually not above a "Richter 2," but also untouchable by ibuprofen. I'm on approximately day six of this, and it is probably time to consult my neurologist. The last time this happened was while I was slowly increasing my dosage, or "titrating up" my Topamax, and it went away with the next dosage increase. Unfortunately, I am at my prescribed dosage, so I can't increase without medical advice. I do know that I am not at a maximal dosage, so I do still have some room to go.