This blog is part of our myths and misinformation series, where we separate migraine fact from fiction. This time we are looking at a myth that sadly can inhibit people from getting to the right doctor or getting the treatment they desperately need. Today we are asking, “Is it a migraine if migraine medications don’t work?”
Many people believe that if medications specifically for migraine attacks do not work (or stop working), you must not have migraine. Some patients have even been told by their physician that they don’t have migraine “because” a specific medication didn’t help them. This is NOT the case! Migraine diagnosis does not depend on someone’s response to any specific medication used for migraine. Let’s look at some reasons why migraine medications may not help even if you DO have migraine.
5 Reasons Migraine Medications May Not Work
Type of medication taken: We all respond to medication differently. What works for you may not work for me. Some people respond very well to triptans, while others may benefit more from gepants. Some people may respond to oral tablets, while others may need a nasal spray or even an injection. Finding the abortive and/or preventive medication that works best with the least side effects may take some time, but it is an important journey to take.
Additional medication may be needed: Migraine can be episodic or chronic, and within the episodic classification it is often broken down further to low frequency episodic and high frequency episodic. If you are only taking acute treatments then it may be time to consider a preventive option which can reduce the number of attacks you have as well as your ability to treat them. It could also be that you need to add an additional preventive and/or additional acute medication. Many people respond best to combination therapy.
Treatment was delayed: We have lots of reasons why we don’t take our medications as directed by our doctor. Sometimes, we have to ration our medicines to ensure we have enough to get through the month. We may ask ourselves, “What if I get a more severe attack next week? Should I try to make it through this attack and save my medication for later?” Other times we have a “wait and see” attitude because we don’t like the side effects of the medication. Or, we decide to try a new “migraine hack” seen on social media first, because we just don’t like taking medication. Regardless of the reasons, we know that for most acute medications, taking them at the first sign of a migraine attack can help decrease its severity and often stop it completely.
Medication adaptation headache: In some cases, if specific types of acute medications are used too frequently, people can start to get a new type of headache. This is called medication adaptation headache, medication overuse headache (MOH), or rebound headache. This doesn’t happen with everyone, and it is only for specific acute medications. If your medication isn’t helping, talk to your doctor. Ask about creating a better preventive plan and adding an acute treatment that doesn’t cause MOH.
Other underlying causes: It is possible for migraine to be a symptom of an underlying medical condition or neurological disorder. For instance, a traumatic brain injury may be a root cause of migraine. Treating these primary conditions may help reduce migraine attacks as well as help make your treatments more effective. It is also possible that the symptoms you are experiencing are not actually a migraine. They may be another type of headache, like a cluster headache or tension headache. If this is the case, you may need a totally different treatment plan to address your condition.
Migraine Is A Complex Neurological Disorder
It takes trial and error to find a management plan that works for your individual symptoms. The most successful management plans include a variety of treatment tools. Medications, neuromodulation devices, at-home and alternative therapies, and lifestyle adjustments can be part of the plan.
Have you have seen a physician who has told you that you don’t have migraine “because a migraine medication hasn’t worked” for you? Then it’s time to see a new doctor, or even a certified headache specialist, who can help you. Also, visit our Migraine Toolbox to learn more about treatment options.