A patient reports that a medication prescribed for recurrent migraine headaches is not working. What action should be taken first?

• A. Ask the patient about the number and frequency of tablets taken
• B. Assess the patient's current pain level
• C. Explain biofeedback as adjunct therapy
• D. Contact the prescriber immediately

Answer: (A)

When a patient reports that a migraine medication isn’t working, the first step is to confirm how they are using it. The most common reason for perceived poor response is incorrect use—taking too few tablets, skipping doses, or not taking the medicine as prescribed. By asking exactly how many tablets they have taken and how often, you can determine adherence and proper dosing, identify potential underuse or overuse that could be contributing to ongoing headaches, and guide appropriate adjustments with the prescriber. If the patient is using the medication correctly and still not improving, you can then explore other options, but verifying proper use comes first. Assessing current pain level or introducing biofeedback are valuable but don’t address whether dosing is being followed, and contacting the prescriber is warranted for safety concerns or adverse effects rather than routine nonresponse.