Maximizing the Effectiveness of Migraine Abortives
My head is screaming; this is definitely a migraine. I’m going to take my abortives now.
This is a version of the conversation many people with migraine have with themselves before taking their meds. Migraine abortive drugs (especially triptans) are expensive and can be hard to get. In medical parlance, this represents “step care,” meaning that you start with the most minimal treatment first and work your way up to stronger treatments.
This strategy makes intuitive sense to patients.
It doesn’t typically work for migraine.
The preferred approach is called “stratified care.” It means hitting the attack with the best drugs you have as soon as you know it’s a migraine. The earlier in the migraine attack that you treat it, the more likely the treatment is to be effective. So, you want to stop the migraine process as soon as possible. The longer you go without medication, the better foothold migraine gets, which makes it less responsive to treatment.
This is true of all acute migraine meds, but critical for triptans. You may think triptans don’t work for you, but it could be that you’re not taking them early enough in the migraine attack for them to have time to work. Studies show that when people wait until the pain is moderate or severe before taking a triptan, the triptan is less likely to work than when taken early in the attack.1
There are drawbacks to stratified care. For one thing, abortive drugs are expensive and insurance, if you have it, may not cover enough for you to use each month. More importantly, when you have more migraine attacks each month than you have migraine abortives, it's impossible to hit every attack with medication as soon as it starts. How to cope with this complication depends on the person. Start by asking your doctor to explicitly outline which abortive meds you can take and how often and what your treatment options are when you’re out of meds. Ask them to help you come up with a plan that will provide you the most relief possible. There might be more medications that you can add to your rotation of acute treatments, ways to predict the severity of your attack, or other techniques to manage certain attacks.
Can you tell when a migraine attack is coming?