Treating Migraine Attacks Early
Created 09-19-2008
To Treat or Not to Treat Headaches...
Elsewhere, we've talked about medication overuse and avoiding the trap of medication overuse headaches. But, it is also important to know when to treat your headaches as well as when not to treat them. Early treatment of a migraine attack is important.
It is important to treat an acute migraine attack in the mild-to-moderate stage, before the pain becomes severe. This way, the medication can work on the appropriate brain receptors (targets) to kill your migraine attack. Some of us tend to wait too long, thinking maybe it isn’t really a migraine after all, or maybe we don’t really need our medication. Maybe a cup of coffee or eating a meal will do the trick.
Waiting too long might itself be a symptom. Your brain may be foggy due to the migraine, and you may not be making wise decisions.
Recent research has found that migraine medications will be more effective if taken when the headache is in the mild to moderate stages, before the headache becomes more resistant, and more stubborn neurotransmitters become involved.
When to treat—treating early vs risk of medication overuse
If you see yourself slipping into a pattern of frequent medication usage, this may indicate the need for a headache preventive medication. Only about 10% of those who would benefit from preventive medications are on an effective regimen. If you are already on a medication for prevention, you should work with your doctor to make certain it is as effective as it could be, and to decrease your pain medications to make certain you are not in danger of developing medication overuse headache.
A recent large population-based study (Bigal et al, 2008) found that barbiturate-containing medications, such as butalbital, and opioids were the most likely to cause a transformation from episodic migraine to chronic headache. The prevalence of transformed migraine is 2.5%, and that due to medication was found to be 1.5%.
Of particular interest in this study was the finding that the number of headache days per month was an important factor in determining risk of developing medication overuse headache. The more headaches you have, ironically, the more susceptibility you have to certain pain medications causing more headaches. It is clear that opiates and butalbital can cause the transformation of episodic migraine to chronic headache (more than 15 headache days per month).
Triptans and nonsteroidal anti-inflammatory medications, however, do not cause this transformation. They only cause more headaches if you are already experiencing a high number of headache days per month. The surprising finding of this study was that NSAIDs can be protective for those who have a low or medium number of headache days per month.
In general, women are more likely to experience transformed migraine. Men, however, are at more risk for transformation due to opiate use, and men who already have chronic headache are more likely to develop medication overuse headache due to triptan usage.
Treatment Satisfaction
Migraine sufferers often think that they have tried everything that there is to try for their headaches, or that their current treatment is as good as it can get. But is that true? There are new medications being developed all the time. What are reasonable expectations for the treatment of migraine?
A reasonable expectation of migraine prevention would be to reduce headache frequency by half, and to reduce headache severity by about half. While many people with mild-to-moderate migraine can become headache-free with medication and lifestyle changes, this is not possible for everyone. If you have been on a preventative medication for several months and you have not experienced at least a 25% reduction in severity, discuss this with your doctor and see if a dose adjustment or a medication change is in order.
With an acute migraine medication, you should expect to obtain some degree of pain relief within the first hour, and should be experiencing relief of associated migraine symptoms with significant pain reduction within two hours. Many people will be migraine-free within two hours. Adding an anti-inflammatory medication to your migraine medication may make it work better. If you develop nausea in the initial stages of your migraine, anti-nausea medication may be helpful also. Be sure to stay well hydrated.
Work with your doctor and stay ahead of your migraines.
1. Bigal, ME, Serrano, S, Buse, D, Scher, A, Stewart, WF, Lipton, RB, Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population-Based Study, Headache, 2008; 48(8):1157-1168
By Christina Peterson, MD
