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Maximizing the Effectiveness of Migraine Abortives

Is this a migraine or not? I’ll chug some caffeine and put ice on my head and hope it goes away.  

I’m pretty sure this is a migraine, but only want to take abortives if it’s really bad. I’ll take an OTC painkiller to see if that helps.

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.

 

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.

  1. Lipton, R. B., Stewart, W. F., Stone, A. M., Láinez, M. J., & Sawyer, J. P. (2000). Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study: a randomized trial. Jama, 284(20), 2599-2605.

Comments

  • Jill M.
    4 years ago

    I’m very happy to say that I tried this yesterday when I was starting to feel dizzy/lightheaded, which are some of my warning signs. I took a Maxalt and within an hour, I was fine! As difficult as it sounds, I try to evaluate how I’m feeling nearly constantly in order to be aware of the signals my body is giving about an impending attack. In addition to keeping a migraine journal using an app on my phone, I’ve found that it’s almost become second nature to do a quick “health check”. It has certainly helped me to realize when a migraine attack is apparent and sometimes even figure out how severe it could become.

  • blueangel1980
    4 years ago

    I have this same conversation with myself every time the pain comes. I try not to end up getting a migraine from the meds because I know if I take them like I would have to following the doctors instructions of “Treat every headache like a migraine.” I would be shoveling medicine into my system more than food. I have talked to her about this and she agrees that i need to figure out if it is going to be a migraine since my head generally hurts a good five out of seven days every week. This struggle is hard especially with four kids and crazy schedules. I am just so glad I have a supportive man in my life.

  • GinaD
    4 years ago

    I have this “to treat or not to treat” conversation with myself all the time, mostly because my doctors have told me to limit treatment to twice a week in order to avoid medication overuse headaches. But what do you do if you have a migraine, to some degree, every day, as I do? How do you decide which ones to treat?

  • Jill M.
    4 years ago

    @Cathy,
    Arbitrary or not, I think it’s a great way to decide when to medicate and when to “tough it out”!

  • Cathy
    4 years ago

    I have this issue too & the doctor also said I should take no more than 2 triptans a week. So how do I decide which ones to treat and which to tough out? Largely I decide on the strength of what I have to do that day. If I don’t have to do much or if what I have to do is easily cancelled, I might decide to have a triptan-free day and just put up with the pain. But if I have to be out doing things and can’t easily cancel, I will take the medication.
    It’s an arbitrary way of deciding but what can you do when you get this many migraines?

  • Marsha
    4 years ago

    I agree that taking triptans at the early onset of migraine is really important. For me, it not only ensures their effectiveness, but helps to minimize the side effects and the migraine hangover I get even when the triptans work (which thankfully nearly always do for me). I understand that, following this strategy, I might at times end up taking triptans when I’ve misjudged that a migraine was coming on, when it wasn’t. But, for me, the downside (taking a drug when I don’t need it) is worth it, even as I try my best to minimize the medications that I take. In terms of being able to get enough triptans per month covered by insurance, I’ve had luck with my doctors advocating to insurance companies that I need more than 6 pills per month. In addition, in the past with Zomig, I was able to successfully get 6 each per month of the pills and the spray — that is, I got around the “six per month maximum” but ordering 6 each of different ways Zomig is administered.

  • Madisonbrooke
    4 years ago

    I wish I could take Triptan, but it gives me seizures. It’s awesome that it helps others though.

  • Maureen
    4 years ago

    Thank you for the reminder. I just sat down to veg a little, and distract myself with the internet to discern whether this is a migraine or not. What I am probably doing is letting the migraine get a better hold. Taking triptan now!
    Really. Thank you. I appreciate it.

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