You’ve talked to your doctor about severity, intensity, disability. You’ve spoken about symptoms, auras, and triggers. You’ve discussed preventatives, abortives, and rescue medications. Have you mentioned speed of onset?
If not, you should. It may be one of the most important pieces of information you can give your doctor, one that could dramatically affect your treatment options.
I have chronic migraines, and most of my attacks come on rapidly, as if out of nowhere. On any given day, I might be going about my business just fine until I suddenly get hit with a wave of nausea, severe vertigo, and an ice pick headache followed by the intense, pulsating pain we migraineurs know too well. I have auras, which give me some warning, but they don’t always occur. Even when they do, the time between the first aura (often aphasia but sometimes dancing spots in my peripheral vision or the curved walls and strange depth perceptions of Alice-in-Wonderland syndrome) and the onset of the pain phase is often no more than five minutes. This leaves little time for preparation, and even less time for abortive medications to work, a factor I hadn’t fully taken into consideration until recently.
Most migrainuers know that abortive medications (e.g., ergotamines, triptans, and Isometheptene mucate compounds) are most effective when taken at the onset of a migraine. If migraines come on very quickly, however, this can be difficult to accomplish, because we may already be deeply entrenched in a migraine before we realize we’re in one and are able to act. In this case, abortive pills are unlikely to work.
Thankfully, there are other abortive medication options. Several of the triptans are now available as a nasal spray and/or as an at-home injection. Migranal, an ergotamine, is also available as a nasal spray. These options generally work faster than a pill, and may be more useful for migraineurs, like me, who experience rapid-onset migraines. Preparation is also key, because chances are, whether you experience relief with abortives or not, there are going to be sometimes when you don’t.
In those instances, it’s important to have a back-up plan, especially if you go from fine to completely disabled in under 30 minutes. Ways to stay prepared:
- Build a migraine tool-kit and keep it someplace easily accessible, such as under your bed or on your nightstand;
- Carry your abortive and rescue medications with you at all times, either in your purse or briefcase or in a keychain pill case;
- Carry cash for a cab and/or know who to call in the event you’re out of the house and are unable to drive home;
- Post your treatment plan – what medications to take, how much to take, and when – somewhere your family, significant other, or roommate can see it;
- Talk to your doctor in advance about an emergency treatment plan (some doctors will arrange for you to go to a local infusion center for IV drugs and/or will write you a note to take to the emergency room in the event of a serious attack); and
- Most importantly, remember – if you experience rapid onset migraines, but haven’t yet told your doctor about them, do so as soon as possible. You may be able to adjust your treatment plan in a way that brings you faster, more complete relief.