Looking at Treating Migraine During Prodrome
As we've discussed before, a Migraine attack can have up to four phases, the first of which is the prodrome. We've long talked about recognizing prodrome symptoms so we have more warning of an impending Migraine, and last year, at the American Headache Society scientific meeting, the question was raised of whether the prodrome phase is too early to treat a Migraine. At that time, the answer was "Perhaps treating during the prodrome is appropriate, and if so, the earlier, the better."
Since that time, Dr. Werner Becker, one of the presenters at that meeting, has continued looking at this issue and conducted another study.1
"The objective was to determine, through a literature review, whether treatment during the premonitory phase of migraine is a potentially useful migraine management strategy."1
This study was a general literature review looking at the nature of Migraine prodrome (premonitory) symptoms:
- reliability in predicting Migraine attacks, and
- effectiveness of medications taken during prodrome.
- Studies looking at what percentage of Migraineurs experience prodrome symptoms had varied results - some as high as 87%, some as low as 33%.
- In some study participants, prodrome symptoms were reliable predictors of a Migraine attack.
- In studies, both naratriptan (Amerge/Naramig) and domperidone (an antinausea medication not available in the U.S.) have been shown effective when administered during the prodrome.
"More research is needed, but there is some evidence that medication treatment during the premonitory phase has the potential to be helpful in selected patients with migraine."1
Summary and comments:
Several studies have now shown that abortive medications such as the triptans and ergotamines work better when taken early in the Migraine attack. Doctors agree with that point pretty much across the board. Where there isn't yet a consensus is on the definition of "early in the attack." Some doctors tell their patients to take their medication at the first sign of the headache; others say at the first sign of aura for those who have aura. Will this change? Will we be told to take our medication as soon as we recognize that we're experiencing prodrome symptoms? I don't know. It may turn out to be like so many other issues related to Migraine — that it varies from one person to the next, and we each need to determine the best time for us to take our medications. In any case, it's good to see this question being investigated.
More on prodrome:
1 Becker, Werner J. "The premonitory phase of migraine and migraine management." Cephalalgia. Online First. January 8, 2012.
2Goadsby, Peter J., MD PhD. "Premonitory Phase of Migraine - Biology and Clinical Characteristics." Platform Presentation. 53rd Annual Scientific Meeting of the American Headache Society. Washington, DC. June 4, 2011.
3Becker, Werner J., MD PhD. "Premonitory Phase of Migraine - Treatment of premonitory Phase of Migraine: What is the Evidence?" Platform Presentation. 53rd Annual Scientific Meeting of the American Headache Society. Washington, DC. June 4, 2011.
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