Dealing with a migraine attack is a little bit like running up a hill. If the migraine is still small, it doesn’t take much effort to get over it and your medicine has a better chance of working. But if the migraine has grown to the size of a mountain, it becomes a whole lot harder to climb. Your medicine will have to work a lot harder to get you over it — and it may not be powerful enough to get you there.
It’s important to treat a migraine attack early. Multiple studies have found that acute medicines work best when taken as soon as an attack starts. Plus, reducing the migraine cycle early may actually reduce your chances of your migraine attacks worsening in the long term.
The best time to treat a migraine attack
The brain and its nerve fibers experience a lot of changes over the course of a migraine attack, resulting in a bigger and more complex headache. The earlier you try to interrupt that process, the easier the migraine is to control through medication (or meditation, or devices). Some cues that it’s the right time to treat an attack:
After your prodrome. One of migraine’s features is its prodrome phase, the early warning phase that an attack is on its way, which includes symptoms such as fatigue, mood changes, yawning and thirst. Since the prodrome can start hours or days before headache pain begins, doctors typically recommend holding off on medication until the headache phase.
At the first sign of head pain. You know the signs of your unique headache. When you feel that pain, act fast and treat your migraine attack before it grows.
- Some people have migraine attacks that come on very quickly, or wake up in the middle of an attack, making early treatment a challenge. If that sounds like you, consider using an acute medication that comes in an auto-injector or a nasal spray, which enter the bloodstream a lot faster than through the digestive system. A few medications also come in tablet form that melt in your mouth, which may work faster than regular pills.
- Many people delay their meds due to uncertainty over whether their pain really signals an oncoming attack, and choose to wait until the pain grows more severe. But that larger headache is harder to fight and may ultimately require more medicine.
- Some people delay pain-relief medicine because of unwanted side effects. Many medications are available, so ask your doctor if another may better suit you.
Treat before your hair hurts. During an attack, nerve cells in the brain become overly sensitized and amplify the pain and other symptoms of migraine. That phenomenon is called “central sensitization.” It’s a reason behind allodynia, the symptom that makes normally non-painful stimulation feel painful, such as touching your scalp or brushing your hair. Once this process has started it becomes hard to stop, so try to treat your migraine attack before your symptoms of central sensitization typically kicks in.
The long-term benefits to early treatment
If reducing the agony of your migraine attacks isn’t enough of a reason to treat migraine early, here’s another good reason. Over time, migraine attacks gradually “reset” the pain pathways in the brain, making the brain more efficient at generating further attacks. That’s right: It’s likely that the more migraines you have, the more you’re “training” your brain to be good at having attacks — resulting in even more attacks.
Think about it. The brain learns by going over and over a pathway to reinforce and strengthen it. If you were learning to play the violin or make a three-point shot, you would practice to gain mastery of technique. Every time you practice, the brain is strengthening that pathway. Similarly, in the brain of someone with migraine, every time an attack comes, the pain pathways are being strengthened to improve their ability to inappropriately process pain signals. The longer migraine goes untreated, the stronger this process can become and the better your brain gets at making debilitating migraine attacks.
The good news is that this dysfunctional pain signaling can usually be reprogrammed with treatment. But the longer someone waits to start treatment for migraine, the longer it may take for this reprogramming — and to run up and over that migraine mountain.