If your migraine treatment isn't working as well as you'd hoped, you're not alone. Migraine affects more than 37 million Americans and is considered one of the most disabling neurological conditions. The effects are even more severe during perimenopause and menopause, when hormone changes cause 29% of women in these stages to experience migraine.
Estrogen plays a key role in nerve function, sensory processing, and brain health, says Hamid Djalilian, MD, professor at the University of California, Irvine, and chair of the Migraine in Otolaryngology Society. When estrogen levels start to swing in perimenopause, your brain becomes more prone to migraine.
You may wonder why your migraine treatment isn't working for severe headaches, increased sensitivity to light and sound, nausea, and other severe symptoms.
You have many treatment options for managing migraine. Your doctor may recommend over-the-counter or prescription medications, laser therapy, relaxation training, or acupuncture to help ease the symptoms.
For a long time, migraine treatment focused on managing symptoms when they flared up, Djalilian says. Now, doctors at the whole picture. It's no longer about just taking pills — it's about adopting lifestyle changes that promote overall brain health.
A treatment may work well on some migraine attacks but not others, or work well for a while and then stop working. Up to 3% of those living with episodic migraine develop chronic migraine. Those who are especially at risk include women, those with frequent headaches, those who don't get enough treatment, and those with complicating factors such as depression, anxiety, or obesity.
The goal of migraine treatment is to lower the number of headache days by 50% and lessen the intensity of your headaches by at least 50%. If you experience a relapse — the return of a migraine attack within 48 hours of a successful treatment — your migraine treatment may not be working well.
Try these ways to lessen the severity of your symptoms or the number of headache days and improve your quality of life.
1. Stick to Your Treatment Plan
Your doctor may recommend a preventive medicine that can prevent migraine attacks or lower their frequency and severity. It can take a few months (and a few dosage changes) for the medication to start working well. Treatments can last 6-12 months or longer. It's important to stick with treatment to get the best results.
Preventive medications can include pills, nasal sprays, or injections. Choose a medication you’re comfortable with to help you stick to your treatment plan.
2. Add Caffeine
Drinking soda, coffee, or another caffeinated beverage with an over-the-counter pain reliever, such as acetaminophen or ibuprofen, can help the medications work better. Research found that 100 milligrams of caffeine — the equivalent of one cup of coffee — was enough to make over-the-counter pain relievers work better for migraine.
While caffeine can help absorb the medication and improve pain relief, it can also be a migraine trigger and could cause stomach pain or nausea, so it's important not to overdo it.
3. Keep a Headache Journal
Tracking your headache days and symptoms is a key tool for managing your migraines. Consider recording details about your sleep habits, diet, and environment, as well as information about medications and how well they worked.
You can share the information you record in a paper journal, smartphone app, or digital spreadsheet with your doctor. The details could help you identify patterns or triggers.
4. Talk to Your Doctor About Combining Medications
Using multiple medications to manage migraine is called combination treatment. It can sometimes work well because different medications target different causes of migraine, making treatment even more effective. But it's important to consult your doctor because not all medications work well together, and some combinations may even be dangerous.
Your doctor will often start by identifying a "baseline treatment" — the medication that works best to prevent or manage migraine — and then add new medications over time to figure out which combination treatment works best and has the fewest side effects.
5. Prioritize Sleep
A poor night's sleep increases your risk of getting a migraine attack, especially for women and those over 35. It's also linked to more severe migraine attacks, anxiety, depression, and a greater effect on quality of life.
Practicing good sleep hygiene — going to bed and waking up at the same time each day, creating a dark, quiet sleep environment, and avoiding caffeine and alcohol before bed — can help you sleep better and lead to fewer migraine days.
6. Break a Sweat
You might not want to lift weights or go for a walk when you have a migraine attack, but movement could help. Exercise is an effective migraine treatment and can help lower the frequency and severity of headaches.
All forms of exercise can help, but strength training and high-intensity aerobic exercises are among the most effective. Targeting major muscles in the neck and shoulders could help ease neck pain that is common in migraine. Running and other high-intensity aerobic exercises release "feel-good" chemicals called endorphins, which help with headache relief.
7. Follow a Plant-Based Diet
The foods on your plate could affect your migraine. Avoid alcohol, chocolate, cheese, processed meats, and other common trigger foods. And try eating more vegetables, beans, seeds, nuts, and grains.
A plant-based diet, including the Mediterranean diet, is linked to fewer, shorter, and less severe headaches. The reason: Fresh fruits and vegetables are rich in plant polyphenols — natural compounds that can have anti-inflammatory effects, which may help with migraine attacks.
8. Manage Stress
Stress is one of the most common triggers for episodic migraine — and it can be one of the reasons that episodic migraine attacks become chronic. Dealing with migraine is also stressful, and the release of cortisol and other stress hormones can worsen your migraine.
Cognitive behavioral therapy is just one of the techniques that can cut stress and help prevent migraine attacks. A therapist can help you identify the stress response and replace harmful thoughts with more helpful, realistic thoughts to help you relax. Meditation can also be helpful.
9. Take Your Meds Sooner
Reach for your medication when you notice the first symptoms of a migraine attack. When medication is taken during the earliest phase of a migraine attack — before the onset of a headache — it can prevent the headache from becoming severe.
This approach is best if you don't have frequent headaches and can identify symptoms, such as sensitivity to light, that are signs that a full-blown migraine attack is coming.
10. Try Alternative Devices
Several wearable devices that deliver stimulating pulses have been approved by the U.S. FDA to treat migraine. The electrical pulses target pain pathways in the brain to help ease migraine pain and can work quickly for some people.
You can use these nondrug options at home to prevent and treat migraine for as few as two minutes or as long as one hour per day. They're often used along with medications. The side effects can include skin irritation, dizziness, nausea, and muscle twitching.
11. Drink More Water
Dehydration can cause migraines. Drinking 1.5 liters of water (about six 8-ounce glasses of water) daily can reduce the number of migraines and headache duration and help you take fewer medications.
To stay hydrated, carry a refillable water bottle and consider adding fresh fruit slices to make plain water more interesting. You can also drink protein shakes and sugar-free sports drinks or eat strawberries, cucumbers, watermelons, and other foods with high water content. It's also important to limit caffeine and alcohol, which can have dehydrating effects.
12. Watch Your Weight
If you're carrying extra pounds or conditions linked to being overweight, like metabolic syndrome, your migraine attacks may be more frequent and severe. Losing weight can help. Studies show that losing weight is linked to fewer migraine days, less pain, and shorter headache duration.
New research also found that glucagon-like peptide-1 (GLP-1) medications used for weight loss helped cut the number of migraine days by almost 50%.
When to Revisit Your Treatment Plan
Living with episodic migraine is a pain, especially when treatments stop working. Make an appointment with your doctor to talk about changing up your treatment plan if these things happen:
- The side effects of your current medication are causing issues.
- Migraine attacks return a few hours after treatment.
- Over-the-counter medications aren't working, and it's time to consider a prescription.
- A single medication isn't enough to address migraine pain and headache frequency.
When a migraine treatment stops working or isn't working well, you may need to focus more on your overall health, Djalilian says.
Migraine is a chronic disease, and treatments may need to evolve. Your doctor can help develop a new treatment plan to help you manage your migraine and improve your quality of life.
