Delaying Migraine Treatment
Do you ever delay treating your migraines?
It's a fairly common thing to do. You think to yourself, this one won't be all that bad. I'll: eat lunch, have a cup of coffee, lie down for half an hour, drink a glass of water or diet soda—whatever thing you think might work that's never really worked before. But you have hope. You have hope that this time you can beat this thing, this space alien invading your brain.
Why do we do this? I've done it myself. It never works. And yet, there is that hope that we can be in control, and not the migraine. I have a colleague who believes that this mistaken belief is part of the migraine itself, that there is cognitive confusion altering good decision-making because of the early stages of the migraine process. If we were thinking clearly, we'd just take our medication. I'm not so sure it's that clear-cut, although that may be the case for some people. There are also issues of weighing out the risk-to-benefit ratios of whether the adverse effects of medication are worth the severity of this headache. There is also the issue of whether you have enough medication to last all month, and if this headache is "triptan-worthy" in light of that.
"Masking the Pain"
I have also had patients tell me they did not want to treat their migraines because they did not want to mask the pain. Now, frankly, this does not make sense. About the only situation I can think of in which this might make sense would be a disaster setting in which one had sustained a head injury and needed to be monitored without benefit of a CT, MRI, or an ICU. Morphine would be withheld so that mental status could be monitored until you could be evaluated in a hospital setting.
However, there is no medical rationale for not taking migraine medication. It will not mask any damage being done to the brain unless your headache is due to something other than a migraine, and something serious at that, in which case you need to be in the emergency department anyway. So, unless you have the red flags that indicate a serious underlying problem, go ahead and take your migraine medication. You do not get points for suffering!
There is also evidence to suggest that early treatment of migraine not only ends an attack sooner, but prevents the pain from becoming fully established.
Red Flags in Headache
Red flags that indicate something serious other than a migraine might be occurring are:
- Significant fever with a headache (more than 99.5)
- Stiff-as-a-board kind of stiff neck
- Severe all-over muscle pains
- Headache that comes on like a thunderclap
- Worst headache of life
- Significant change in headache (not just it used to be on the right, and now it's on the left - that's actually okay)
- Any neurologic symptoms that are not part of your usual aura
If you have any of these, see your doctor or go to the emergency department for evaluation. It might not be anything serious, but better safe than sorry. And otherwise, treat your headaches. Unless you enjoy pain?