Treating an acute attack of migraine.

STEP 2 Recognize Migraine as a Process.—While headache and migraine are often considered synonymous, they are not. Migraine is always more than headache. Learning the non-headache symptoms associated with your migraine is essential to early recognition of an attack. The headache-associated symptoms of a migraine attack are divided into 3 components: (1) symptoms occurring before the headache begins; (2) symptoms associated with the headache; (3) symptoms occurring after the headache resolves. Symptoms beginning before headache often predict that the migraine will progress and require treatment. The Table lists common pre-headache symptoms. The Figure depicts different phases of a migraine attack. The ideal time to treat is in the shaded area of the Figure. Regardless of the medication you use, treating migraine at this point generally provides the best results. After treating a given migraine attack, use this diagram to assess where in the migraine process you treated and how you might improve your strategy next time. In scientific studies the percentage of people achieving pain-free status within 2 hours of treatment has been almost double for those treating early (when headache is mild in intensity) vs those treating when headache is moderate or severe. With successful early treatment headache also is less likely to return, and there are fewer side effects from the medication taken. Can you know that a mild/early headache will develop into a disabling migraine if early treatment is withheld? Yes. In one study, 93% of migraine sufferers who typically notice symptoms of migraine before headache could accurately predict a disabling migraine at the onset of the mild headache. This means that with practice and close observation, most people effectively can treat early, when the headache is mild, and not waste medication by treating headaches unlikely to develop into full-blown migraine.