Brief Answer:
Need to document headaches and their properties

Detailed Answer:
Good morning. My name is Dr. Saghafi and I would like to help you with your problem. My understanding is that you suffer from migraine headaches and have tried some medications without success. Currently you take Frova but are still experiencing breakthrough headaches, "...doesn't always work."

In order to get a much more precise idea of what you may need to do to make Frova work "better" for your headaches it will be necessary to keep careful track of your headaches and how they behave while you take your Frova as directed. By keeping a headache diary you will be able to track things such as duration of the headaches, intensity and disability ratings of the headaches, symptoms (e.g. nausea, vomiting, sensitivity to light and sound, etc.). You will also track EXACTLY how you are taking your medications so that your specialist can offer you suggestions on more selective timing of the medication so that it has a better chance of completely treating your headaches.

In addition, the headache diary will help understand just exactly HOW MANY headaches you are having so as to determine whether or not you may benefit from being on some form of preventative therapy which in and of itself may help reduce your migraine headaches which you are seeing as "breakthrough" episodes. As it is you state that you have headaches daily. Does that mean you take Frova daily? This is a problem and is against manufacturer's recommendations as to how the medication should be taken.

Therefore, please consider doing the following in order to help your neurologist or headache specialist guide you to a better regimen of medications or interventions for your headaches:

1. Consider obtaining either a headache specialist or neurologist who can follow your headaches if your primary doctor is not familiar with the details of how to instruct you on compiling data and then, analyzing the same in a headache log.

2. Obtain a headache log from your doctor (or the internet....there are many types) and start keeping strict track of as many parameters and symptoms of your headaches as possible until you next see your doctor. In other words, we want you to document a snapshot of what's going on NOW so that we can develop a baseline to work with which can be compared to future diaries once changes are implemented.

3. Timing of the Frova may be very important and helpful to how your headaches respond. Also, very importantly here is the fact you are having daily headaches. If you are using Frova daily then, you are already violating one huge edict in headache medicine which is "THOU SHALT NOT OVERUSE" any abortive medication. REASON? By using triptans (and that means FROVA) on more than 10 days per month for headaches the patient can actually BEGET more frequent headaches, more intense headaches, and worse than those would be more difficult to treat headaches.

Please let me know if you have any other questions that I may answer.

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