A clear ladder. As long as it is offered to you in time.
Migraine is easily treatable. There is a constructive step-by-step plan from attack medication to modern preventive measures. The trap is not in the lack of treatment options, but in how long people keep trying painkillers on their own before they arrive at the right step.
What a treatment program could look like
Recognise the attack and treat in time
Paracetamol or an NSAID (ibuprofen, naproxen) for milder attacks, taken as early as possible in the attack. In case of nausea, an anti-emetic can improve absorption.
Triptans with insufficient effect
Triptans have been specifically developed for migraine and work best early in the headache phase. If the first triptan does not work sufficiently, another triptan from the same group may still work: it is partly a matter of trial and error.
Keep an eye on overuse
If you use triptane 10 days per month or more, or 15 days or more with simple painkillers, for 3 months, there is a risk of medication overuse headache. Discuss this with your GP before it gets to that point.
Preventive (prophylactic) medication
If you have 2 or more attacks per month, preventive medication can reduce the number of attacks: beta blockers such as propranolol or metoprolol, or anti-epileptics such as topiramate.
Botox or CGRP inhibitors via the neurologist
If several previous preventive agents have insufficient effect, the neurologist may consider botulinum toxin or a CGRP inhibitor: a newer class of medications that specifically targets the protein that plays a role in migraine attacks.
For medication overuse headaches: discontinuation under supervision
The first step is to completely discontinue all headache medications for 2 to 3 months. That sounds tough, and it is, but in most cases the attack frequency decreases afterwards. This is preferably done in consultation with a GP or neurologist.
What you can ask yourself
State the frequency with your GP
Take a headache diary with you: how many days a month do you have pain, and how many days do you use medication. That one overview often changes the entire conversation.
Actively ask about preventive options
If there are 2 or more attacks per month, prophylaxis is worth considering. It is not always offered on its own.
Ask for further advice if the effect is insufficient
After a few failed attempts with triptans or prophylaxis, a referral to a neurologist or headache center is a realistic next step.
Seek free support if you get stuck
If you cannot find a solution with care, an independent client support worker can you think along. That's free.
🏎 Need immediate help?
In case of immediate danger to yourself or someone else: call 112. Are you in distress or are you thinking about suicide? You can call or chat with 113 Suicide Prevention day and night via 0800-0113. Zorgfuik is not a crisis service and cannot solve acute requests for help, but we think it is important that you know where you can go.