Managing migraine pain before it begins: Understanding prodrome, early treatment options

Migraine is a complex neurological disease that disproportionately affects women during their most productive years.

For many, migraine attacks can be disabling, leading to missed time with family and friends, days off from work or school and disruptions to important activities. Managing these attacks early is key to reducing their impact on daily life.

One of the most effective strategies for managing a migraine attack is to treat it early, before the pain becomes moderate or severe. NSAIDs and triptans are typically first-line treatments for migraine. Administering these medications at the earliest onset of symptoms can reduce the likelihood of a migraine becoming debilitating. Yet, many patients delay treatment, hoping the headache will resolve on its own, or they may not have medication accessible when needed. In other cases, they may avoid taking medication out of fear of running out of their limited prescription or concerns about overusing medicine.

New insights into early migraine treatment

Recently, new data have emerged supporting the treatment of migraine during its earliest phase — prodrome.

Prodrome is a set of consistent warning signs that occur hours to days before the aura or headache phase of a migraine. For many individuals, recognizing prodrome symptoms can serve as an opportunity to intervene and prevent the migraine from escalating. Some of the most common prodrome symptoms include neck pain, fatigue, irritability and mood changes.

This new understanding has led to the exploration of medications that can be used to treat migraine during this early phase. One such medication is ubrogepant (Ubrelvy, AbbVie), a calcitonin gene-related peptide receptor antagonist. Ubrogepant has been FDA approved for the acute treatment of migraine and has shown promise in reducing migraine severity when taken before pain begins — specifically, at least 1 hour before the onset of prodrome symptoms.

Why early treatment matters

By treating the migraine in the prodrome phase, patients may be able to prevent the headache phase entirely or significantly reduce its severity. This allows for greater control over the migraine and helps minimize the disruption that migraine can cause to daily life. For those who experience frequent or severe migraine attacks, having this additional option in their toolkit is a game-changer.

To summarize...

With new research emphasizing the importance of early treatment, individuals with migraine have another opportunity to manage their condition effectively. Rather than waiting for the pain to worsen, early intervention — sometimes before the headache even starts — can make a substantial difference in reducing the impact of migraine on daily life.

Key takeaways to discuss with patients

The following tips may help improve patients’ treatment outcomes:

• Act quickly: Treat migraine at the earliest signs of onset, particularly if you experience prodrome symptoms like neck pain or fatigue. Only ubrogepant has been studied to be effective in treating migraine prior to the pain phase.
• Know triggers and signs: Pay attention to early warning signs or consistent patterns during the migraine, so you can intervene early.
• Consider new treatment options: Discuss early treatment alternatives, especially if patients experience frequent disabling attacks.

References:

• Burstein R, et al. Ann Neurol. 2004; doi:10.1002/ana.10786.
• Dodick DW, et al. Lancet. 2023; doi:10.1016/S0140-6736(23)01683-5.