The 6 Most Common Reasons Migraine Treatments Fail

Patient Expert

There are over 36 million American Migraineurs  suffering day in and day out with Migraine and headache  pain. Dr. Lawrence Newman,  director of the Headache Institute at the Roosevelt Hospital in New York City, recently discussed some of the reasons he feels Migraine treatments fail and patients aren't  getting the relief they need.

â—Š The first problem is the** Wrong Diagnosis**.  Dr. Newman  sees many people go to the doctor as the weather changes when they have runny noses and their head hurts.  Barometric pressure changes affect many people with Migraine disease, but when they see their  doctor he may think they have allergies or sinus headache. What is truly happening is a Migraine attack in 90% of cases.    See Migraines Often Triggered By Change In the Weather.  Another problem  is many doctors  think Migraine pain is unilateral (one sided) when in fact many times the pain can be bilateral (two sided).    Dr. Newman also said that stressful situations may exacerbate a Migraine, or they even may have Tension-Type Headache. Doctors may see these as another disorder altogether, designating the patient  "anxious."  In this situation the patient won't get the proper medication.  A Migraine specialist is  the expert who devotes his entire practice to treating people with Migraines and headaches. Our artice  Migraine and Headache Specialists - What's So Special  has more information. If you need help finding a Migraine specialist, you can find one in our patient recommeded directory  HERE.

â—Š Another problem may be  the** Right Diagnosis - Wrong Treatment**.   Most people with Migraine  try over the counter (OTC)  medication such as acetaminophen first. These may not the best choice if Migraineurs have nausea and light sensitivity with their  attacks, Dr. Newman said. Many times over-the-counter medications (OTC 's)  are not enough, and prescription medication is needed to treat the Migraine.  With so many types of medications available, it is difficult to tell the difference between them. Preventive, Abortive, and Rescue Medications - What's the Difference?  will clearly explain them.

â—Š Now that we have the right diagnosis, we may come across the** Right Medication -  Wrong Dose** issue. Dr. Newman suggests that Migraine medications  be prescribed at their highest dose for maxium effect.  He said starting at the lower dose  won't work and should only be started at a lower dose if there are potential side effects. Dr. Stephen Silberstein, director of the Jefferson Headache Center and Professor of Neurology at Thomas Jefferson University,  on the other hand, suggests that Topamax, a medication used for Migraine prevention,  be started at a low dose and  slowly tapered up, saying this is essential for its success.  (This is also Dr. Newman's philosophy when it comes to medications such as Topamax, but it is not how it came out in the article written about his views on  treatment failure.)  An important note,  when we start new medications, it may  take up to three months to see a reduction in our Migraine frequency and severity.

â—Š What happens when we have the** Right Dose, Right Medication but  Wrong Forumlation**?    Sometimes  nausea and vomiting are a serious problem for Migraineurs during an attack. For some, keeping down oral medications is nearly impossible, I've been there.  With over 100 medication options  to treat Migraine disease, there are  different forumlations of drugs available.   For example triptans, (medications that stop the Migrainous process) such as Imitrex, which also comes in  injection and nasal  spray  forms;Maxalt  also comes in  a  tablet that  melts in your mouth; Migranal Nasal - is a nasal spray. There are also suppositories to help with these conditions.    Many times it feels like we have tired them all,  but if we take a careful look at the list, I'd bet there are a few left.    Migraine Preventive Medications - Too Many Options To Give Up!_      _

â—Š Delaying Treating  is a big problem many Migraineurs. Waiting too long to treat a Migraine attack.  Dr. Newman  recommends  Migraine attacks  be treated within 40 minutes. If a  Migraine  is not promptly treated with  medication  it may not stop at all. Or we may take our medication too late and  it will only work for a little while, thus never getting rid of the Migraine.  Indeed, a new study backs this up. See Taking Triptans During Migraine Aura May Work Better.

â—Š Dr. Newman said** Overusing Medication**  is another problem that interfers with our Migraine treatment. Medication  overuse headache (MOH)  may occur when certain over the counter (OTC) and/or prescription medications are  taken for Migraine  more than two to three days a week. The only way to stop this pain is to stop taking the offending medication. Medication Overuse Headache - When the Remedy Backfires. As if MOH weren't bad enough, new research shows that if we have MOH, we may be at increased risk for ** Transformed Migraine** too.

Migraine prevention is the way to go. With the help of a good Migraine specialist, education about Migraine disease,  and support you can feel better.


Doyle, Jessica Ryen. "6 Reasons Your Headache Treatment Is Failing You."  FoxNews.Com. April 22, 2009.