Situational Prevention of Migraine Attacks: Can Early Treatment Change the Conversation?

Migraine is a common disabling neurological condition for which head pain is the most common bothersome symptom. People with migraine also experience other associated symptoms, such as nausea, photophobia, phonophobia, fatigue, and neck pain, though these symptoms can start and end at different times during the attack. Associated symptoms can be as disabling as head pain, and—as they continue—can interfere with activities of daily living. Treating earlier in an attack before central sensitization may be more effective in preventing the development of other associated symptoms during a migraine attack. To understand how to discuss early treatment with patients with migraine, it is important to understand the phases of migraine and how to consider treatment during prodrome. Several studies have evaluated the treatment of migraine as early as prodrome. A study of ubrogepant used during prodrome showed improved prodrome symptoms and reduced the chances of proceeding to the headache phase of migraine compared with placebo. Another time to treat early is during situations known to cause migraine, such as menses. Data have shown that certain acute treatments taken regularly during the menstrual cycle and starting before the onset of migraine can be effective in reducing migraine attacks related to menses. In this article, we discuss the data available on treating migraine attacks early, both during prodrome phase and for the situational prevention of migraine during predictable triggers. Further clinical and real-world data are needed to continue to explore this concept and provide better management options for patients.