The Risk of Overusing Migraine Medications

Q. Does a person build up a resistance to migraine medication? I used to take Zomig three to four times per week and it quit working. Now Maxalt isn't working either because I am getting more frequent headaches.

A. There isn’t an easy answer to your question. I can tell you, however, that many people who suffer from frequent migraines do not have a good preventive treatment plan in place. Frequent migraines, more than one per week, often lead to an overuse of medications for the acute symptoms of the nasty head pain; this, in turn sets up a vicious cycle leading only to more headaches. These are known as medication overuse headaches (MOH). In other words, it isn’t that you are resistant to your medications, but it may mean you are using them too often. When this occurs, we need to change your treatment plan and employ preventative strategies.

The American Migraine Prevalence and Prevention Study estimated that preventive therapies could lessen the severity and duration of migraine headaches, as well as decrease their occurrence by up to 80 percent. These preventive approaches include medications such as antidepressants, beta-blockers, anti-seizure drugs and stress-reducing techniques (biofeedback and relaxation training). Supplements (magnesium, coenzyme Q 10, riboflavin and the herbs feverfew and butterbur) may help to decrease both the frequency and intensity of your migraine headaches. Also, basic lifestyle strategies such as eating regularly, avoiding migraine “trigger” foods, getting enough rest and exercising are key elements of a preventive plan.

Regarding your current treatment, the drugs mentioned are part of a group of medications known as triptans. These are used for the acute treatment of migraines, and are usually very effective in keeping them from escalating to a full-blown, incapacitating headache, as well as giving symptom relief if the migraine has already begun to pound. We currently have seven choices of triptans. Although they work in a similar way, there are differences among the drugs in how quickly they provide relief, how long this relief will last and their potential side effects. Also, the method by which you take the medication varies. Some triptans dissolve under the tongue, others are in traditional pill form and others might be a nasal spray or even an injection. Because of the differences, it is not unusual for a patient to get more relief from one of these medications than another. For example, if your migraines are accompanied by nausea and vomiting, a medication that dissolves under the tongue or given by injection may be more effective and better tolerated.  I want to add that triptans don’t work for everyone. They aren’t used if you have ischemic heart disease or suffer with hemiplegic migraines.

With that being said, in order to design an effective migraine management program, your health-care professional will need to know your medical history, if other family members suffer from migraines and your particular headache pattern. You’ll want to note this information:

• The location of your headaches
• How often they occur (daily, weekly, monthly)
• The type and quantity of medications you take (aspirin, acetaminophen, non-steroidal anti-inflammatory, triptans, narcotics)
• Other symptoms (nausea, vomiting, visual changes, sensitivity to light, odors or sounds)
• What triggers your migraines (emotional stresses, diet and food preservatives, excessive fatigue, weather changes and menstruation)
• How long your migraines last (hours, days or even a week).

Needless to say, migraine headaches get a person’s attention. The debilitating symptoms can lead to social isolation, absenteeism from school or work, and days "lost" in dark rooms. Thankfully, this no longer needs to be the case. With the active interaction of patients with their health-care team, preventive therapies and the targeted use of acute medications, migraines won't be in control of the quality of your life--you will!

Read More About Headaches and Migraines on MSN Health & Fitness:

• Reality Check: Migraine Headaches
• Diagnosing Headaches
• Headache Cures: First, You Kill a Snake
• Talk About It: Migraines and Medications

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)