Attack-Based Care: Timing

Written by Shoshana Lipson | March 8, 2022

Have you ever woken up with a full-blown migraine attack? Sometimes I even dream that I am having a migraine, and then the pain gets so bad that it wakes me up and—voila! Sadly, it wasn’t a dream at all! Figuring out how to treat that monster, compared to treating an attack that you catch in the first few minutes, is a whole different animal. It’s a situation made more challenging by all the other symptoms that often go along with a full-blown attack such as vision impairment, dizziness, vertigo, vomiting, and more!

Thinking about that raises an interesting question: Should you treat migraine attacks differently based on how far into the attack it is when treatment starts? Just to simplify things here, we’re going to focus on the attack phase when some of the most debilitating symptoms occur. Hopefully that will help give us a springboard to figure out how this applies to our own specific situations, and to put together an attack-based care plan for ourselves.

Full-Blown Attack

Once you are in full-blown attack mode your treatment options may be more limited. Not only will there be a heightened sense of urgency about the need to get relief from the pain and other symptoms, but some of those symptoms may have reached a level where certain treatments are no longer feasible to administer, or they may simply be ineffective.

For example, for some people, vomiting and extreme nausea is more likely in a full-blown attack, so oral medication is not likely to help. You may have worsened vision loss, or be shaking too badly to manage doing a self-injection, especially if it involves filling a syringe from a vial. You most likely will be in too much pain to wait up to two hours for an oral treatment to work.

Obviously, all this limits your options and changes your treatment plan. For me, this is the time when nothing else matters but STOPPING THE PAIN ASAP, and of course, staying out of the ER!

Beginning of the Attack

On the other hand, if you are able to start treating an attack in the first few minutes, or at least within the first 30-60 minutes, things might look very different. Bear in mind that we are talking about initiating treatment very soon after your FIRST SYMPTOMS. By that I don’t mean necessarily pain, but whatever symptoms you know initiate the start of the attack phase of a migraine for you. For me, that generally means sudden nausea and racing heart, but all of us are different.

At this stage, you may be able to start with non-prescription options such as ice or heat, dark glasses, green light, lying down in a dark room, medical devices, or medications that might take longer to kick in.

If your earliest symptoms don’t include severe nausea and/or vomiting, then oral medications may be viable, versus having to figure out alternatives such as nasal sprays, injections, urgent care, or the ER. Some people may even be able to take a lower dose of medication and thereby preserve their prescription for more severe attacks.

Somewhere In the Middle

Honestly, for me, figuring out an attack-based care plan for a full-blown attack and an attack I catch early is relatively easy. The tricky part is knowing what to do when it falls somewhere in between. What should you do if you are catching an attack relatively early but it is a fast escalating attack? What about if you were away from your treatment “go bag” and couldn’t start until at least 1 hour in? So many different factors figure into this situation, including severity of symptoms, pain level, and attack triggers (things we will talk about in other blogs), but it all goes into the often complex calculation of what to do.

Questions to ask might include:

  • Am I able to take the time to go and lie down for a while, or even the whole day?
  • Do I have enough medication to get me through the month?
  • Do I have responsibilities such as young children who can’t be left unsupervised?
  • Do I have to drive home, or somewhere else?

Let Us Know

Do you have an attack-based plan that takes into account how quickly you are able to start treating a migraine attack? Have you talked with your doctor about what to do with a full-blown attack versus one you catch early on? How do you make your decision?!

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