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If you suffer from migraine attacks, you’ve undoubtedly developed some coping strategies. You may have a favorite medication to treat migraine pain, or perhaps you have a tried-and-true preventive medication that you always take. But at some point, you might experience some symptoms or changes in your usual symptoms that warrant a visit to your doctor. And if you have relied on Excedrin Migraine, a popular over-the-counter (OTC) combination medication, you might want to call your doctor to discuss alternatives, since that combination drug may not be available for a while. Consider these five reasons that might inspire you to schedule a visit with your doctor.
Drug manufacturer Novartis announced in January of 2020 that it was voluntarily pulling Excedrin Extra Strength and Excedrin Migraine off the shelf for the foreseeable future. (It also pulled Bufferin, NoDoz, and Gas-X Prevention.) The company noted broken or chipped tablets or even tablets from other products might have gotten mixed in with the drugs. You might accidentally get a product contaminated with an unexpected ingredient that could cause an allergic reaction, or your Excedrin might contain too much of a particular ingredient, raising the possibility of an overdose. Without this treatment option, you may be scrambling for something else. This is a good chance to talk with your doctor about the best alternatives to try.
Watch out for increases in the frequency or intensity of your headaches. If your migraines have started getting worse, or you’re having them more often, that’s a cue to call your doctor. If your migraines wake you up at night, that could be another sign. When your headaches begin to disrupt your activities of daily living–or make a bigger impact than usual–that’s another cue.
A good way to keep track of possible changes is to keep a headache diary. You can describe the length and intensity of your headaches after they occur, along with the time of day and what you were doing when they happened. Then you can look at your diary to notice a pattern over time.
If you take a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen more than you should, you may start experiencing even more headaches. These medication overuse headaches (MOH) are a common result when people take these meds too often. And “too often” might not even be as often as you’d think; the American Migraine Foundation suggests the threshold is more than twice per week. You may also hear the term “rebound headaches” to describe these headaches. You have to be especially careful if you’re taking combination medications because you might wind up taking a dose that’s too high, which can cause other problems, too.
Another reason to call your doctor and make an appointment: your migraine pain is getting worse, but your OTC treatment is no longer cutting it. It might be time to switch to prescription-strength pain medication, or a prescription medication designed to prevent migraines from occurring in the first place.
Prescription medications that are available to you include:
- Prescription-strength NSAIDs: These can be more powerful than OTC NSAIDs and offer more relief.
- Triptans: These drugs are intended to address headache pain, not prevent headaches. Meds in this category include sumatriptan (Imitrex), eletriptan (Relpax), rizatriptan (Maxalt), and zolmitriptan (Zomig).
- Ergot alkaloids or ergotamine, such as Ergomar or Migranal: You would take this kind of drug to treat a headache that’s already started, not to prevent them from happening. However, it can cause blood vessels in the brain to narrow and cause potential side effects.
- Opioid painkillers: These can effectively relieve pain; however, these drugs can be highly addictive and increase your risk of medication overuse headaches.
- Blood pressure-lowering medications: These include beta blockers such as propranolol, or calcium channel blockers. These meds are aimed at prevention.
- Anticonvulsants: An anticonvulsant seizure medication like valproic acid can be used to prevent migraines.
- Antidepressants: Various types of antidepressants have been shown to ease pain associated with migraines.
- Monoclonal antibodies: These are some of the newest drugs approved by the U.S. Food and Drug Administration (FDA) to treat migraine pain; the drug class includes the preventive medications erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab-jjmr (Vyepti) as well as two newer drugs designed to address acute pain, lasmiditan (Reyvow) and ubrogepant (Ubrelvy), both of which are available in tablet form.
There are also some combination drugs available, like Treximet, which combines a triptan and an NSAID to treat acute migraine pain.
Your doctor will want to discuss the pros and cons of these options. For example, some of them, like ergotamine and valproic acid, can have serious side effects or interact with other medications you might be taking.
If you keep a headache diary–or even if you don’t–you’re probably aware of what you typically experience during a migraine. You might recognize the early signs that one is brewing, and you’ll know if you are likely to become nauseated or dizzy.
However, if you experience certain symptoms unlike your usual ones, that could be a sign something serious is wrong. Watch out for these red flags:
- Severe sharp headache that arrives with no warning
- Headache after experiencing a head injury
- A new type of headache unlike others you’ve experienced
- A headache that gets worse if you’re lying down, coughing, or sneezing
- Headache that comes with a fever, stiff neck, weakness or numbness, or confusion
- Headaches that develop later in life, in your 40s and 50s
Here’s another reason why you shouldn’t blow off changes in symptoms: Research suggests people who have migraines with auras are at increased risk for stroke–and that’s especially true for women. You don’t want to miss a sign of something serious like an impending stroke by dismissing an early symptom.
The bottom line is any unusual developments in your pattern of migraines can justify a call to your doctor. And if your medication doesn’t seem effective, that’s another reason to schedule an appointment, as it might be time to take another approach. It’s also a good chance to ask your doctor about lifestyle changes or complementary therapies that could help.
