Migraine treatment can be very complex and depend on the type of migraine experienced. For instance, how someone would treat episodic migraines—migraines that come and go with no distinct pattern—may vary from a chronic migraine treatment plan. Chronic migraine is defined as 15 or more days per month with migraine and headache.
It is still unclear what causes migraines to switch from episodic to chronic. But effective acute migraine treatment may help prevent that change. Dr. David Watson, a certified migraine and headache specialist and director of the Headache Center at West Virginia University, explains why acute migraine treatment is crucial for migraine control.
What does acute migraine treatment mean?
Acute migraine treatment is what you do when the migraine occurs. You want to do it typically as soon as possible and, ideally, early in the course of the migraine. Early, appropriate acute treatment has the best chance of stopping migraine symptoms with the fewest side effects, and can limit the amount of time of the pain and disability.
Some research has looked into the connection between poor acute treatment of migraine leading to the development of chronic migraine. What is your take on this?
I think that headaches can lead to more headaches. By allowing a migraine to go full-fledged, the brain seems to become more sensitive to other migraine triggers, even after the symptoms of the first migraine have resolved. This can lead to an increase in migraine frequency. The hardest part about creating a treatment plan is balancing benefits with side effects/negative effects.
What factors play a role in turning episodic migraine into chronic migraine?
Many risk factors, including overuse of acute medications, use of certain acute medications like opiates, and lack of prevention of high frequency episodic migraine.
Why is it harder to get migraines back to episodic after they have become chronic?
Chronic migraine usually has something under the surface which got to that point. Once chronic, it is important to address underlying issues of medication overuse, sleep disturbance, mood disorders, etc. Also, the chronic nature makes these things worse so it is a vicious cycle
What are some of the other possible consequences of poor acute migraine treatment?
Increased need for emergency department visits, urgent care, opiates, borrowed medicine, unnecessary suffering, work loss, and social loss.
How do you see acute migraine treatment changing in the future?
Currently new targets are being studied, like calcitonin gene-related peptide (CGRP), and new delivery systems are developing. Also, neuromodulation (nerve stimulation) with different devices and approaches is being developed.