Ive tried about every migraine preventive and treatment medication there is. Doc asks me what to do. What do I try now?
I used to have the same problem as you too. There are a lot of things you can do to prevent or lessen your migraine.
First, are you seeing a neurologist with regards to your migraine? Did a neurologist diagnose you with one? You might want to consider getting a neurologist especially one that specialises in headaches and pain management. Obviously your current doctor have run out of options and it might be better to have a second opinion.
Anyway, you could start first by a headache diary. It might help you spot a trigger, which will in turn lessen you migraine attacks if you avoid them. This is the best way to minimise your migraine attack.
Whenever you have a migraine, write down the day, date, time, what you have eaten for that day, how long the migraine has lapsed, the pain score (from 1-10, 1 being the least), emotional factor (what was mood, were you feeling depressed, angry or stressed?), what medication have you taken to lessen the pain, and the pain score after the medication.
From there, you might be able to spot patterns like certain food triggers your migraine, or certain days eg mondays because you are in a rush so you didn’t eat breakfast thus lack of food therefore migraine.
What about time? Are you in a very hot or cold place at a particular time? That could trigger migraines. Fluctuating weather and temperature could also trigger migraine. A change in season too. Some people can predict weather by their offset in migraines.
What about stress? Some people get migraine when they are extremely stressful, especially during examination periods, year end job review and so on… That could easily set off a migraine attack…
What about menstrual migraine? some people get migraine before their menses…
Why not you try keeping a headache diary for a month. Then try to spot patterns. From there, see if you can make changes in your lifestyle and hopefully reduce migraine in your life.
Next, are you on a lot of pain medications? By a lot, are you taking them more than 3 times a week? Rebound headache (headache from medication overuse) is the most common headache seen after migraine.
If you are stop. You will realise that your head hurt a lot. After that, your migraine will hurt less.
After all these, if you are considering preventatives, you can try preventative medications like topamax or beta blockers like proprananolol or tricyclic like amitriptyline, these are the more common drugs use to prevent migraines.
Studies have shown that acupuncture works in decreasing the frequency and severity of migraine as well.
There are some off label use of botox which worked for some (botox could last about 3-6 months depends on a personal basis).
As for off label use of alternative medication, some studies showed that taking Coenzyeme Q10, Riboflavin and magnesium have an effect of reducing the frequency of migraine.
Pain medication that are available include over the counter medications like paracetamol, aspirin or presciption medication like ultracet, oxcodone, vicodin as well as temporary relief nerve blocks for people who have a migraine attack (where preventatives are quite useless). There are also medications like Sumatriptan or its derivatives that targets the the treatment of migarine.
Lastly, before a migraine start, you would have a prodrome. Do you have a particular food craving or mood swings? Yawning, fatigue, excessive sleeping are also some symptoms. Some people have diarrhea or constipation as well…
During a prodrome, try taking metoclopramide, it might reduces the migraine or even prevent it.
Talk to your neurologist (if you have one if not find one!) and discuss your options with him/her. S/he will be able to help you go through all your options base on your medical history.