The Treating Early Principle

Understanding and implementing the “Treating Early Principle” is crucial for effective migraine management. From recognizing early signs to keeping your medications accessible, this guide offers practical solutions to common issues that cause delayed treatment. Discover how early intervention can save your day and reduce pain with our expert tips and strategies.

Are You Treating Your Migraine Attacks Too Late?

Many individuals delay taking their medications until the migraine pain becomes severe, but research shows that treating a migraine attack early can significantly increase the chances of success by up to 40%. In the case of gepants, even treating during the prodrome (i.e., 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 various reasons. Here are some common reasons for the delay in treatment and tips on how to treat earlier.

Can you increase your treatment success rate? Record your results in a migraine diary.

Common Reasons for Delayed Treatment and Solutions:

1. Problem: I’m not sure if it’s a migraine.
   Solution: 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. 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. Observe yourself.

2. Problem: I do not have my medications with me.
   Solution: Create a migraine kit with your medication for easy access.

Put your medications in a little pouch or box and carry it with you. Have another one in your car or at work. Make sure you have enough medication for any scenario, including when you travel. If you live with migraine, attacks will happen; be prepared to fight back!

3. Problem:  My attacks start fast, or I wake up with them, or I have nausea, and I
   throw up.
   Solution: Ask your healthcare provider for more options.
   

Some medications work quickly, like nasal sprays, injections, etc. See our post on strategies for managing nausea and vomiting with migraine and listen to Episode 2: Severe Attacks of our Migraine Talks Podcast.

4. Problem: I am afraid of side effects.
   Solution: 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.

5. Problem: The pills are costly.
   Solution: Ask for more affordable options and evaluate the benefits.
   

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 weigh the cost of the medication against the price of a lost day, then make the decision that is best for you. 

6. Problem: I have been told to avoid overuse.
   Solution: Use a migraine diary and consider gepants.
   

Medication overuse headache is a frequent issue (see our posts on medication overuse here and here). If you have 10 or fewer headache days requiring treatment per month, the risk of chronification by overuse is low. If you have more than 10 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. This is a tricky situation to discuss with your healthcare provider. 

Gepants are a new class of acute medications. 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 healthcare provider.

Conclusion: Treat early and save the day! 

By adjusting how you use your medications, you may achieve better results and experience less pain. Not convinced? Conduct your own experiments using a migraine diary. Try treating a few attacks early to see if it’s more effective for you. Don’t let migraine ruin your day!

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