Are you an early jumper or a waiter?

Some people with migraine like to treat their attacks as soon as they first recognize symptoms. Others tend to wait and watch their migraine develop, waiting to see if it's going to become "severe enough" to warrant medication.

Over the last few years, doctors have been educating patients about identifying early hallmarks of migraine, like cravings, mood changes, sensitivity of the scalp, that can signal a migraine attack is on its way and then advising patients to treat early. But does treating early really make a difference?

Results from the TEMPO study that will be published in the journal Cephalalgia later this year help answer this question. This study evaluated 144 migraineurs who regularly used triptans. Researchers evaluated how these patients typically treated three migraine attacks. About half of the patients treated migraines with a triptan early, taking their triptan less than 60 minutes after their migraine had started. The other half waited, treating their headaches after an hour or more had gone by. Researchers looked at how long it took migraines to resolve and what happened when those who typically waited for treatment were taught to treat early. Here's what they found:

  • Migraine pain was gone 2 hours after taking a triptan for 53 percent of those treating early compared with 30 percent waiting for at least one hour before taking their triptan.
  • When waiters were trained to treat before an hour had gone by, 54 percent were free of migraine pain within 2 hours of taking a triptan.

These data clearly support advice to treat your migraine early to get better results. If you're one of those people with very frequent migraines, you probably can't take acute medications to treat every migraine early. As you know, overusing acute migraine drugs can lead to a worsening of migraines called medication overuse headache. For this reason, you'll need to limit acute migraine medications to a maximum regular use of about 2 or fewer days per week. For those with frequent attacks, you might be able to use a diary to monitor your migraines to see what marks an impending severe attack. For some of my patients, they've found their milder migraines never get beyond a severity of about 5 or 6 on a zero to 10 severity scale. Once their migraine hits a 7, though, they know it's going to escalate into a disabling attack. Rather than waiting for the attack to become disabling and then treat, they treat when they hit a 7 severity. Also, you can begin to you those non-drug treatments you might find to be effect for migraine attacks, like relaxation techniques, exercise, or distraction, early for all of your attacks. Early non-drug treatment will likely be more effective than waiting for symptoms to worsen.

So are you an early treater or a waiter? And if you're a waiter, try treating earlier and then let me know what happened -- if it made a difference in how quickly your migraine resolves. Let's see if tips from this study will help your migraines.

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