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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (19)
  • Mixi
    4 years ago

    I was a “waiter” for a long period of time, trying so many different things, options…… only to find out that no matter what, NOTHING(not even time) could stop a migraine of happening!!!
    So now I am an “early jumper” and my migraine are gone after a couple of hours. I have 4 to 6 migraines per month.
    I always take a triptan and it’s THE ONLY thing that will work for me !!!!!

  • Sally
    4 years ago

    I face this dilemma constantly. I too was concerned that I was using either the triptans or the DHE too frequently. So I decided to “ride out” a headache with only Haldol and Cogencin. Well, what started as a 5 quickly blew into an 8 and lasted 2 days. It also threw me into a bad headache cycle that lasted over a week. So now I am really hesitant to try this again. Any advice out there on how you cut back your triptan usage. Also, the DHE is a wonder drug for me but I can no longer get it here in PA. Has anyone been able to get it anywhere?

  • valeriebellows
    4 years ago

    I’m a “waiter.” The doctor has me on Imetrex, but I can only take them when I go to bed. They make me feel lethargic, nauseous and totally out of sorts. That doesn’t help though when a migraine sneaks up on me in the middle of the day. Usually when that happens, I’ll take Excedrine. But I have to be careful with that too. I get nosebleeds easily and aspirin thins the blood.

  • MigraineSal
    4 years ago

    I am a jumpaiter . . . this means that I alternate between the two, depending on the symptoms I have and where I am when the problems start !

    I am on daily preventative meds and managed to reduce the dosage successfully but I do seem to be getting intermittent symptoms ( thankfully not the full blow head pain I used to get ). The main problems I currently seem to suffer with is pain behind my eyes and in my left cheek / sensitivity in my scalp / neck pain and nausea and I will take various courses of action to address these, depending on where I am and the time of day. If I have arrived at work and will not be driving for a while I will take an abortive medication, if it is starting to have an impact on concentration . . . if I am at home I get my iced wheaty bag out of the freezer and lay with it in the small of my neck and meditate with a cooling eye mask on to see if this helps as I can usually ” zone out ” of the sensations while meditating. Luckily for me both courses of action work extremely well, on the whole ( probably only because I am on a preventative med ). If I am going to be driving within a few hours of the feelings starting, or not at home and able to lie in a cool, dark room I have to be a waiter until I am able to do either of my two preferred methods but I drink plenty of water and try distracting techniques. I am sooooo pleased that people have referred to random smells in this tread as on Tuesday night ( a just short of migraine night ) I was hunting for a very irritating perfume type smell that I thought was giving me a headache and making me feel sick !

  • Meggietye
    4 years ago

    I fall into both categories now that I have read “The Migraine Brain”. This 11.00 pocketbook has a long list of weird & wacky things that happen to us that indicate a migraine has begun that most people would not usually even consider…like the itchy ears I have had for 10 yrs!! I have been to 3 docs and not one knew this can happen with migraine..I mean, who knew??!! Now when my family see me with my fingers in my ears, scratching away, they remind me I am getting a migraine. The information in this book has been a game changer in my treatment of migraines. I have bought and given away 4 copies of this book and everyone says the same thing – that no one told them 99% of this stuff and now they feel much much more in control of their health life. It is definitely a godsend. As much as I wish I had this information 20 yrs ago when this began for me I am just very grateful I have it now.

  • afinkel
    5 years ago

    I am a chronic migraineur. I wish I could be a “jumper” but, like many of you, I am limited to x number of triptans I can have per month so I wait most of the time. I also try to follow my neuro’s advice: if I have an important event, and a migraine is beginning, I take a triptan. If I can rest at home instead of taking a triptan, I do that. This doesn’t always work, because some of the migraines are disabling, so even if I can rest at home, I simply don’t want to be in pain! It’s hard, very hard to make a decision to take a triptan, even with this guide, but it helps a bit. Luckily I don’t have too many important events!
    I used to have MOH but stopped all over the counter meds and reduced my triptan usage from about 20 a month (a couple of years ago when my company was generous) to less than 8. So I take nothing for my headaches/migraines except a triptan when I absolutely need to. If the triptan doesn’t work, I have a prescription for Toradol and Maxeran, which I might need 1-3 times a month. Most of the time, I’m in pain. Such is my life.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi alise and JT63332,

    I was absolutely a waiter thinking “it” wasn’t really a migraine or would magically go away! As I’ve gotten older I am getting better at listening to my body and taking abortives when a migraine starts. 🙂

  • alise
    6 years ago

    Used to be a waiter, but now I know better. My migraines never go away without proper medication. What helped me was that a neurologist said; one migraine attack does more damage to your body than all those pills do!!

  • JT63332
    6 years ago

    I used to wait. Have had migraines (pre menopausal) for 18 months….. I tried jumping in early and just got it the day after medication…. tried waiting and suffered….. tried homeopathics, natural medicine, diet, drugs, combinations….. my worst one was 5 days long…. I have always had such great health, high pain tolerance, healthy lifestyle blah blah blah,,,, the migraines are now having a toll on my working and family life… I feel sad and hopeless when I am bent over a bucket, vomiting in a dark room when I want to be making lunches for my family and going to work….now the doc says I must take twice daily beta blockers, double the triptans(?) anti inflammatories and take anti emetics…. till menopause, maybe 6 to 8 years… I fear the last week of my cycle, its like I have a body that is not one I know or recognise… I am scared my brain is deteriorating from this trauma.. I can handle the headache just about but the nausea vomiting diarrhoea phantom smells loss of finger tip sensation slurred confused speech and agitation is sending me up the wall…

  • alig0118
    6 years ago

    I’m a waiter. I can’t take triptans because I have hemiplegic migraines and I’m scared to get medication overuse (MOU) migraines. I had a MOU migraine for over a month this summer. My neurologist wants me to take my medication, Fiorinal, as soon as I feel a migraine coming on. I work full time and do need to take my medication every day or every other day.

  • Kelli Smith
    7 years ago

    I agree with several of the previous commenters. I try to be a jumper, but am probably more of a waiter because of the sad need to hoard the medication for the worst of the worst migraines. If I could get as much medication as I actually need, I would be a jumper, no question. I also have them too frequently to use the triptans at the onset of any migraine symptom… but as I get older, I feel a little better capable of knowing which ones are going to be full blown a little quicker than I used to.

  • Robin Miles Thompson Yarbrough
    7 years ago

    I am typically a waiter – those precious as gold Imitrex must last. I’ll usually start with 2 Aleve and drinking lots of water. I might add phenergan or a muscle relaxer depending on how severe my symptoms are. Mine usually start with a flutter behind my right eye, stiffness in my neck and phantom smells. I think we all know where our ‘breaking’ point is regarding the abortive but I do think I allow myself to suffer too long before taking the Imitrex.

  • Katie Osborne
    7 years ago

    im a jumper. I am still trying to work full time. I usually take ibuprofen at the first whisper of head pain. If I’m at work, I go for triptans, if I’m at home, I go for pain medicine. However, the # of attacks I’m having is about 4/ wk. It’s been rough. I’m seeing my neuro in 3 days though and hoping to try something new…

  • Tammy Elder Rome
    7 years ago

    I’m a “waiter” on using abortives because I have so many migraines each month that I could risk MOH. I can usually tell which ones will respond to analgesics, NSAIDS, or triptans thanks to keeping such a long and detailed diary. However, I do use accupressure on my trigger points, aromatherapy, massage, extra water, room darkening, etc. as early interventions. I almost always do something within the first few minutes of a warning. Today is a perfect example: I felt tenderness in my right eye and immediately started massaging the trigger points on my right temple. I was able to abort the impending migraine before it got bad enough to need medicine treatment. Tomorrow I might not be so lucky, but I will take today for the blessing that it is.

  • Elaine Gross
    7 years ago

    I’m a waiter….it took a suggestion the other day from my husband when I said the bottom of my face was all tingly and I was smelling something like wet nasty diapers (I get phantom smells – it’s weird and nasty), he said “Why don’t you take your migraine medicine?”. Wow, now there’s an idea! So I did and it went away. The only problem is I am a chronic migraineur and I can only do this twice a week and I get these symptoms almost every day, especially the odors. At least I can take phenergan for the nausea when it gets bad, and I have pain patches.

  • Cathi
    6 years ago

    The random smells! Thank you for posting that, I thought I was nuts looking for a sour smell in my house! This had been going in for over a year, my migraines started a year and a half ago, and periodically I will search the house looking for ‘ that smell’! If it were a constant smell it would’ve easy to find, bu incomes and goes! I do think you have solved my mystery!

  • Jamie Warn
    7 years ago

    It depends, if I am at work or doing something I cannot take a break from, I take my medication, but if I am at home or a family member’s house then I excuse my self, find a dark noise free room (witch can be hard to do at family get togethers cause there any where from 2-5 children running around) and try to sleep it off, I, for lack of a better term, am lucky cause I have a lot of family members that suffer from Migraines, so they understand what I need to do. The Only time I take meds when I am at home is when it goes into my jaw (I also have TMJ) and I cannot open it.

  • Lynne Schultz
    7 years ago

    Unfortunately I’m a waiter-I’m only allowed tryptans twice per week-In theory I can use those up by Tuesday. Then I am stuck with a headbanger I can’t treat on Friday. I know I should treat ASAP, but the fear of a real nasty one later in the week makes me overcautious 🙁

  • Dysa Lindsey
    7 years ago

    I used to always wait – only was able to get 9 Imitrex pills per month (per insurance) and I didn’t want to “waste” them. Now that I receive more than that (thru the VA) I take right away and notice I never “wait” for the headache to go away – it just…goes away…

  • Poll