WHAT ARE MY OPTIONS?
Q: My doctor tells me I can try a preventive medication for my Chronic Migraine. I’m worried it won’t work since nothing else has. How long do I need to try one to see if it will work?
A: Chronic Migraine is notoriously difficult to treat. OnabotulinumtoxinA was, for several years, the only agent approved by the FDA to treat the problem. I tell my patients to let me treat them with it on at least three occasions 12 weeks apart. If there is no effect, we might try something else, but it often takes more than one session for people to see a difference. More recently, three types of CGRP monoclonal antibodies have been approved to treat Chronic Migraine. If the first one you try doesn’t work, you can always switch to another! It’s not clear yet if a different CGRP will work if the first one you try doesn’t, but it’s always worth trying.
IS MY TREATMENT STRONG ENOUGH?
Q: I was diagnosed with episodic migraine last year and have been taking a prescribed triptan when they hit. The triptan helps, but my migraines seem to be coming on more and more often and getting tougher to fend off. Do I need to switch medications?
A: It is commonly the case that migraines get worse over time, often peaking in intensity in your early 40s. So it is not surprising that they are getting tougher to treat! Most adults with migraines these days use triptans (several types of these are available), unless there is a medical reason not to. These often work well, especially when taken at the first sign of an attack. However, if you have a lot of migraine attacks and frequently treat them with acute medications, you run the risk of developing “medication overuse headache.” In general, if you have six or more headache days monthly or you use acute medications more than twice a week, you may benefit from preventive medication.
DOES BIOFEEDBACK WORK?
Q: A few folks in my migraine support group have recommended biofeedback, but I’m skeptical. How does it even work?
A: EMG (electromyogram) biofeedback teaches you to reduce muscle tension, GSR (galvanic skin response) biofeedback reduces stress (it’s similar to what is used in a lie detector), and skin temperature biofeedback is used to warm hands, indirectly changing blood flow. All of these can help people with migraine — most of the time in conjunction with taking medication — and can be taught by either a physical therapist or a psychologist. Look for one who specializes in the procedure.
OUR EXPERT: Mark W. Green MD, FAAN, Director of Headache and Pain Medicine, Professor of Neurology, Anesthesiology, and Rehabilitation Medicine, Vice Chair of Neurology for Continuing Professional Development and Alumni Relations, Icahn School of Medicine at Mount Sinai, NY