Migraine treatment not helping: what to track before neurology follow-up

Quick Answer

If migraine treatment is not helping, the safest preparation is a clear headache diary plus an accurate medicine list. Track when headaches happen, how long they last, symptoms that come with them, possible triggers, what medicine you actually used, side effects, missed work or school, sleep, menstrual timing if relevant, and questions for the neurologist.

NINDS describes migraine as a health condition with symptoms that can include recurring headaches, nausea, vomiting, mood changes, tiredness, and sensitivity to light, noise, or smells. MedlinePlus notes that migraine triggers can vary and may include sleep changes, stress, some medicines, caffeine changes, skipped meals, bright lights, smells, weather, and other factors. NICE recommends considering a headache diary to aid diagnosis and discussion, including frequency, duration, severity, associated symptoms, medicines used, possible precipitants, and menstrual relationship when relevant.

The goal is not to prove the treatment is wrong. The goal is to make the follow-up visit specific.

Build a headache diary your neurologist can scan

For each headache or migraine attack, note:

• date and start time,
• how long it lasted,
• where the pain was,
• pain quality in your own words,
• how severe it felt to you,
• nausea, vomiting, light sensitivity, sound sensitivity, smell sensitivity, dizziness, visual symptoms, speech symptoms, numbness, weakness, confusion, or other symptoms,
• what you were doing before it started,
• sleep, meals, stress, weather, screen exposure, alcohol, caffeine, exercise, travel, or menstrual timing if relevant,
• what helped, what did not help, and how long relief lasted,
• whether you missed work, school, caregiving duties, driving, or normal activities.

Do not force every headache into a label. Let the clinician use the pattern.

Track medicines as actually used

Bring:

• the prescription plan you were given,
• what you actually took and when,
• over-the-counter medicines,
• supplements or herbal products,
• medicines taken for other conditions,
• side effects or reasons you avoided a medicine,
• pharmacy labels or photos if the names are confusing,
• prior migraine medicines and why they were changed, if you know.

The FDA says a medication list should include prescription medicines, nonprescription medicines, vitamins, supplements, allergies, and key details that help health professionals understand current use. NICE also includes prescribed and over-the-counter medicines in headache diary recommendations.

Do not change migraine medicines because of this article or AI. Bring the pattern to your clinician.

Add context that affects the visit

A useful neurology follow-up packet may include:

• previous neurology notes,
• emergency or urgent-care notes for headache,
• MRI, CT, eye exam, or lab reports if ordered for headache,
• other diagnoses that affect medicine choices,
• pregnancy, trying-to-conceive, or breastfeeding context if relevant,
• work, school, caregiving, driving, screen, sleep, and mental-health impact,
• what outcome matters most to you.

NINDS notes that doctors may ask for a headache journal to help diagnose migraine and find treatment, and may ask for timing, intensity, activities before onset, and symptoms.

Questions to ask at follow-up

Use questions like:

• "Based on my diary, what pattern do you see?"
• "Does the diagnosis still fit, or do you need more information?"
• "Which symptoms in my diary matter most?"
• "Could medicine timing, actual use, side effects, or other medicines be part of why I am not improving?"
• "What should I do if a planned medicine does not help or causes side effects?"
• "What warning symptoms should make me seek urgent care?"
• "What should I track before the next visit?"
• "Do you need reports from another doctor, eye exam, imaging center, or emergency visit?"

These are safer than asking the internet to choose a new medicine.

What Not To Ask AI To Decide

AI can format your diary, summarize patterns, and draft questions. Do not ask AI:

• whether your headache is migraine, cluster headache, tension headache, stroke, tumor, or another diagnosis,
• whether your current treatment is wrong,
• which migraine medicine you should take,
• whether to increase, reduce, stop, combine, or switch medicines,
• whether your symptoms are an emergency,
• whether imaging is needed,
• whether your neurologist missed something.

Headache diagnosis and treatment decisions belong with a clinician who can review the history, exam, risks, medicines, and reports.

When to seek urgent help

Seek urgent or emergency medical care for severe symptoms, rapidly worsening symptoms, fainting, severe breathlessness, chest pain, confusion, signs of stroke, severe allergic reaction, new neurological symptoms, a sudden severe headache, headache with fever or stiff neck, headache after head injury, or any symptom that feels like an emergency. NICE lists several headache features that clinicians should evaluate for possible further investigation or referral, including sudden-onset headache, fever with worsening headache, new neurological deficit, and new cognitive dysfunction.

If you already have a personal action plan from your clinician, follow it.

Create your Between Doctors profile

Between Doctors can help organize:

• headache diary,
• medicines as prescribed and as actually used,
• side effects and missed doses,
• triggers and context,
• function impact,
• prior reports and visit notes,
• questions for neurology follow-up.

It does not diagnose headache type or choose treatment.