What to Try When Nothing’s Working

When migraines fail to respond to the usual therapies, we can believe that we are either cursed or that we have missed something. Only one of these thoughts allows us to move forward. When we believe that we have missed something, we go back to the beginning. We repeat a history and physical looking for missed clues. We consider intervention previously tried and those untried. We adopt new approaches and mindsets that allow patients to become comfortable with being uncomfortable. When people say that they have done everything, it should be pointed out that it is unlikely that they have “done everything” because they have not found out what the next thing to do is. There are multiple interventions that have demonstrated benefit in refractory cases, and if these interventions fail to improve the condition, then it is always appropriate to adopt new perceptions and behaviors regarding pain. It is always too early to quit.