Q: What should I do to stop a migraine attack?
A: The first thing you must do is take the attack seriously and treat it immediately. You will need to use a combination of approaches to abort (stop) an attack. An effective plan for aborting a migraine attack is to stop doing whatever you are doing and rest, take medication that can completely alleviate the headache and associated symptoms in less than 2 hours , and avoid low blood sugar levels and dehydration. It is extremely important that all of this is done together and as soon as the attack starts.
Q: I can usually ride out a headache. Do I need to treat a migraine attack?
A: Yes you do. Treating a migraine attack successfully is about time, not pain. As soon as you start to experience a migraine attack, you must stop the attack as quickly as possible; the longer you wait to treat the attack the more difficult it becomes to stop it. Your treatment for individual attacks is just as important as is the preventive treatment because the longer your migraine attack lasts, the more vulnerable you are to having another one.
Q: Why does a migraine attack become more difficult to treat with time?
A: As a migraine attack progresses there are physiological changes (changes in body function) that can make the attack more difficult to treat. In the brain, the pain response system is disrupted, causing a cascade of pain responses that makes pain harder to control. In the digestive tract, there is a delay in emptying of the stomach, which affects the absorption of medications into the bloodstream (see Can gastric stasis affect medications other than those I take for migraine?).
Q: How do changes in the brain during a migraine attack influence the effectiveness of medication?
A: Normally, the brain can reprogram its pain control system, much like a computer that has been loaded with “spam” or “pop ups.” You can think of migraine attacks as “headache pop ups.” Since migraine is a disruption of brain cell function, the longer the “migraine” program runs, the more “headache pop ups” happen to you. This process is called central sensitization. The development of central sensitization makes medication aimed at stopping an attack less effective; abortive medications are more likely to stop the headache completely when used before the cascade of pain responses of central sensitization starts. The only way to accomplish this goal and stop the headache is to take the medication early on in the attack and use the medication that works the best and fastest for you.
Q: How do problems in digestive tract function affect medications aimed at stopping an attack?
A: Research studies have shown that during a migraine attack there is a delay in emptying of the stomach. The movement of stomach contents through the digestive tract is called gastric motility, and a delay in gastric motility is known as gastric stasis. The longer a migraine attack, the more severe the gastric stasis becomes. As a result, medications for treating migraine are not absorbed into the bloodstream as quickly and efficiently as they would be otherwise. For this reason, a migraine attack cannot be completely stopped if there is a delay in treatment.
Q: Can gastric stasis affect medications other than those I take for migraine?
A: This is a very good question but one that has not been properly studied. If you are having frequent migraine attacks, which we know influences the absorption of migraine medication, then it is possible that any medication taken in pill form could be similarly affected.
Q: Why can’t I just wait for the headache to get bad enough before I take my medication?
A: To treat migraine effectively, you need to understand that it is a “time thing not a pain thing.” Many people wait for the headache to get “bad enough” before they take their medication. Over the years I have heard every reason possible for not treating attacks when they start, from “it might go away” to “I am afraid I will run out of medicine” or “I will use too much medicine.” The fact is that migraine will not magically go away and, furthermore, the longer you wait the more likely it is that you will have more attacks. Overusing an abortive medication is a reasonable concern, which is why migraine prevention is as important as the treatment. However, when you do have an attack, any delay in treatment allows progression of central sensitization, in which an increasing number of sensory nerves are recruited into the pain process, making the attack more difficult to treat. The longer you wait, the more vulnerable you will be to further attacks.
Q: How do I deal with other people who think it is “just a headache” and do not understand why I must stop what I am doing and treat my migraine attack?
A: Dealing with those around who do not understand migraine can be very challenging. Do not take on this kind of challenge during a migraine attack—it wastes time and causes more stress. Take care of yourself and the migraine attack first and deal with people later. Many people who do not suffer from migraine do not understand that the illness is about more than just pain. Taking the time to educate the people in your life about your condition is very important, but you only need to educate them, not change their belief system. You do not have to make excuses for your illness. It is what it is. People must accommodate your illness just as they would any other chronic medical condition, such as asthma or diabetes.
Q: What if I cannot leave work or stop whatever I am doing to treat a migraine attack?
A: If you address a migraine attack early on in the process with aggressive, effective treatment you will rarely need to stop what you are doing for long periods of time. There are very few jobs or projects during which you cannot stop for a few minutes to treat the attack. If your job is so important that you cannot stop to treat a migraine, then it is certainly too important to do with a migraine attack. Migraine is not simply a headache. The disruption in brain function during an attack affects your job performance. In addition, the longer you wait to treat a migraine attack the more attacks you will have and the more your job and life will be adversely affected.
Q: Is it important for children to treat their migraine attacks early?
A: Yes, children and teenagers often delay treatment of their migraine attacks to the point where they become very ill. They are often reluctant or fearful of asking a teacher to excuse them from class to go see the school nurse. Parents may encourage this behavior because they are concerned about their child using medication. Yet very often, all that is needed early in the attack is rest, food, and water. If medication is needed to treat a migraine attack, delaying treatment will simply mean that more medication will be required. Children, like adults, can go on to develop chronic migraine (headaches on more than 15 days a month) so it is crucial that attacks be contained.
Q: What if the migraine attack starts while I am sleeping?
A: Migraine attacks can happen during sleep and place you at risk of a very severe attack. When you wake from sleep with a migraine attack, it is crucial that you start treatment quickly. You may find the attack very difficult to treat. If it continues for 2 hours after treatment, it is very important that you treat it again even if it is “better.”
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