The Treating Early Principle
My doctor prescribed me medications to treat my migraine attacks…but they don’t work! Sounds familiar? You may be treating your attacks too late.
I have been told to wait until my pain is severe to take my meds. Isn’t that the right thing to do?
No, it’s not! Think of a migraine attack as a fire (it is an inflammation, after all). It is easier to control a small fire than a big one! Research has shown that treating a migraine attack early increases the chances of success by 40%! In the case of gepants, even treating during the prodrome (the early phase of migraine symptoms before the pain kicks in) has been shown to work well.
Almost every patient with migraine will initially use their acute medications too late, for many reasons. Here are some common reasons leading to a delay in intake, and some tips on treating your attacks earlier. Can YOU increase your success rate? Record your results in your diary https://migrainetracker.ca/
Problem: I’m not sure it’s a migraine
Fix: observe your pattern and try treating a possible attack
Migraine attacks start in all sorts of ways. It’s not always easy to be sure that a migraine is starting. Observe yourself. But sometimes…you know it’s a migraine, but you don’t want to admit it. Don’t let false hope keep you from treating on time.
Problem: I do not have my meds with me
Fix: get a migraine kit
It’s a common problem. You need to make a migraine kit. Put your meds in a little pouch or box. Carry it with you. Have another one in your car or at work. Make sure you have enough medication, including when you travel (LINKIN Travel 1107). If you live with migraine, attacks will happen: be prepared to fight back!
Problem: My attacks start fast, or I wake up with them, or I have nausea, and I throw up
Fix: ask your health care provider for more options
Some medications work quickly, like nasal sprays, injections, etc. See our other handout on this topic (See this post) and listen to Episode: 2 Severe Attacks on the Migraine Tree Podcast.
Problem: I am afraid of side effects
Fix: try, observe, and ask for more options
All medications can have side effects. Try what you have been prescribed. Discuss other options with your healthcare provider if there are troublesome side effects. Finding what works best for you may take a few different trials.
Problem: The pills are costly
Fix: ask for more affordable options and evaluate the benefit
Medications can be costly. If they are effective, consider buying them in a larger amount to save on pharmacy dispensing fees. Shop for the pharmacy with the best deal. Make sure you get the generic options. And finally, weigh the cost of the medication against the price of a lost day, then make the decision that is best for you.
Problem: I have been told to avoid overuse
Fix: Use a headache diary and consider gepants
Medication overuse headache is a frequent issue (See posts MOH 1 and MOH 2). If you have ten or fewer headache days requiring treatment per month, the risk of chronification by overuse is low (See this post). If you have more than ten days per month, keep a diary. Start a preventive agent. Try not to treat the milder headaches so that you can treat them on more severe days. See our information on non-medication strategies and apply a combination approach. This is a tricky situation to discuss with your healthcare provider.
Gepants are a new class of acute meds (See this post and this PDF Acute Gepant). They block the CGRP
receptor and are also used as preventives. They do not lead to medication overuse headache.
They can therefore be used to decrease the use of other acute meds that could cause
chronification if taken too often. If you are using a CGRP antibody, you may not use gepants
on a regular basis (they share the same mechanism). Discuss with your health care provider.
Conclusion: Treat early, and save the day!
By changing your way of using your meds, you may have better results and endure less pain.
By adjusting how you use your meds, you may achieve better results and experience less pain. Not convinced? Conduct your own experiments using a headache diary. Try treating a few attacks early to see if it’s more effective for you.
See our Don’t let a migraine ruin your day! Video
REFERENCES
Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011;83(3):271-80.
Lanteri-Minet M, Mick G, Allaf B. Early dosing and efficacy of triptans in acute migraine treatment: the TEMPO study. Cephalalgia. 2012;32(3):226-35.
Valade D. Early treatment of acute migraine: new evidence of benefits. Cephalalgia. 2009;29 Suppl 3:15-21.
Post#807
