If it doesn't work – what could be the reason?
If you have read the above information carefully, you may be thinking that you have been treated with this or that medication for a long time – one that your doctor strongly recommended – and yet you still suffer from severe migraine attacks. There are a number of problems that can occur in headache therapy – both on the part of the doctor and the patient.
Below you will find a list of possible sources of error. Please consider these as honestly and objectively as possible. If you realize that you have made mistakes yourself, you should discuss this with your doctor. If you notice that the difficulties lie with your doctor, you should discuss this with them or ask for a recommendation for another doctor experienced in specialized pain therapy. Please always keep in mind: Migraines that cannot be improved at all are practically nonexistent. And here are the most common sources of error:
- This is a different type of headache. It could be due to a lack of analysis, but also to incorrect information you gave your doctor.
- The patient is inadequately informed about possible triggers or the patient has contributed too little information from their self-observation (migraine diary).
- Unrealistic goals were not addressed: A "miracle drug" or "miracle methods" that solve all migraine problems are, unfortunately, not yet known. Simply lying down passively during acupuncture does not work. The statement "it didn't help" points to a flawed understanding of migraines: it's not "it" that can help; the patient must actively participate in their own recovery. The patient must take responsibility for their condition and not leave treatment solely to the doctor. This also includes consciously structuring daily life in a way that minimizes the likelihood of a migraine attack.
- Unused options for migraine prophylaxis: Migraine prophylaxis aims to reduce the use of medication to treat attacks. If these options are not fully utilized, the risk of chronic headaches due to medication overuse and other side effects increases.
- Insufficient sensory deprivation: Patients should place themselves in a low-stimulus environment (dark, quiet room) and relax instead of continuing to work. Failure to do so will result in an increased need for medication. Additionally, the medication may not be fully effective.
- Taking the medication too late.
- Incorrect dosage form: Administering acetylsalicylic acid in tablet form, for example, leads to unreliable absorption, especially if the tablets are not taken with sufficient liquid (at least 250 ml). Therefore, use as an effervescent solution is strongly preferred. If the migraine is accompanied by vomiting, substances administered via the stomach may be poorly absorbed.
- Underdosing: Taking 500 mg of paracetamol or 500 mg of acetylsalicylic acid is usually not sufficient to stop migraine attacks.
- Acute overdose: Excessive intake of medication can itself lead to vomiting and nausea.
- Chronic overdose: The prolonged use of medications to treat migraines can lead to chronic headaches due to medication overuse.
- Administration of combination preparations or taking several medications: The combined intake of different substances increases the risk of chronic headache due to medication overuse.
- Failure to provide information about the dosage method: Patients must be informed that an antiemetic should be administered at the beginning and painkillers should be taken a quarter of an hour later.
- Taking sumatriptan via Glaxopen during the aura phase: This will not prevent the resulting headache phase.
- Ineffective medications: Sufficiently effective substances are still being used to treat migraines. This is particularly true for the administration of opioids and other psychotropic substances.