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Medication-Resistant Migraine: What’s Next When You’ve Tried Everything?

Medically Reviewed By Lisa Valente, MS, RD
Jaime Sanders_Medication-Resistant Migraine What’s Next When You’ve Tried Everything

“Your migraine may be medication resistant.”

I was at an appointment with a new neurologist to discuss alternative treatments for my chronic migraine, since other standard therapies had failed me in the past. At the time, I was exhausted from continually being disappointed by the lack of efficacy of the preventive and abortive medications prescribed to me.

After discussing my medication history, he said my migraine might be medication resistant. Before hearing that, I had always felt internalized blame for not controlling my migraine. This neurologist had validated that it was a complication of the disease – not me – that was at fault for still having chronic migraine episodes. Looking back at his notes, he stated I had “a history of migraines refractory to traditional treatment options.”

Since childhood, migraine was always approached by my care team as something that I had complete control over. If I was having too many attacks, it must be because I was being noncompliant with my medications or had poor control over my triggers. My relationship with migraine changed immediately after my doctor acknowledged it was refractory, which impacted the way I sought treatment. 

Migraine is a complicated neurobiological syndrome. There is no cookie-cutter approach to managing migraine.I am not to blame if my disease does not respond to standard treatment of care.

“Have you tried….?”

For 15 years now, I have been tirelessly trying to reduce the severity and frequency of my migraine attacks. No one specific therapeutic strategy has helped; instead, I’ve focused on maintaining a multipronged approach to managing my migraine. For so long, I tried hard to find a treatment that would prevent migraine attacks, and a treatment that would help ease the pain in the moment. That meant trying multiple classes of medications for years, all of which didn’t work, which took an incredible toll on my mental health.

One of the more frustrating aspects of migraine is the unsolicited medical advice I get from well-meaning folks. Many people do not understand that refractory migraine is challenging to treat. Over the years, I have tried numerous therapies, including essentially every prescription medication and injection available. In addition, I’ve made lifestyle changes and tried to incorporate healthy habits into my routine, including:

  • acupuncture
  • massage therapy
  • chiropractic adjustments
  • biofeedback
  • meditation/relaxation/deep breathing/mindfulness
  • homeopathic and naturopathic medicine
  • neuromodulation
  • lifestyle modifications (nutrition, exercise, sleep hygiene, trigger management)
  • supplements
  • pain psychology and cognitive behavioral therapy (CBT)

What comes next when everything else has failed?

I’ve learned that successfully managing refractory migraine means using multiple approaches, often with the guidance of a team of healthcare professionals. At this point, my efforts have not been working. Because of the continuous daily pain, increasing disability, and decreasing functioning and quality of life, I recently decided to enter into an inpatient headache treatment program.

After talking it over with my doctors, it’s become clear that specialized headache care at an inpatient headache treatment program will be an important step in gaining control over my refractory migraine.I will be spending up to a week at a dedicated headache unit that specializes in treating headache disorders with the goal to make me pain-free. This program is located in a different state, so I will be away from my family. However, my husband will be there with me. Some of the goals my treatment team and I will work on during my stay are to:

  • break the acute cycle of headache using a combination of drugs and treatments
  • change the course of my headache disease
  • improve migraine symptoms and function
  • discontinue harmful or counterproductive medications or treatment habits

To help achieve those goals, I will attend groups and classes designed for headache patients, meet with mental health professionals to address quality-of-life issues, and work with the treatment team to build a successful outpatient treatment plan once my stay is over. I hope that with these interventions, I can begin to get my life back.

As much as I want to be excited about starting this program, I am cautiously optimistic about whether it will be successful for me. I want it to work, but there has been way too much disappointment on this journey for me to be 100% hopeful about it. At this point, I have decided to lean into the hard truth that I am burned out from putting so much effort into healing with such little reward. I expect disappointment more than success and I am okay with that.

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Medical Reviewer: Lisa Valente, MS, RD
Last Review Date: 2023 Apr 14
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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.