Migraine: how often do meds work?

Siri Hustvedt writes of a life with very severe migraines. After many referrals and medication trials she gets by with biofeedback-trained relaxation techniques and, I would guess, some over the counter analgesic.

This prompts me to confess that, in my days of seeing patients, I felt very unsuccessful treating migraine.

Now that was over 10 years ago, but the medications haven't changed all that much. I used the medications I'd read about, and some of my patients even sat through several rotations, but nothing seemed to stick.

Some meds worked for a while, but then the patient would return. Sometimes a med stopped working, sometimes the side-effects were worse than the headaches, sometimes they were too expensive.

I know others claimed much more success, but I'm suspicious. I know quite a few people with migraine, and they mostly seem to live with them. They often have meds that help about as much as the ones I used to prescribe, and sometimes they need stronger narcotics, but by and large they, like Siri, live with migraine.

Maybe I wasn't imagining things long ago. Maybe we really don't have any great medical treatments for migraine. If so, then it might be useful to admit that in print ...