Rescue treatments for a migraine to save your day
Migraines can be unpredictable, debilitating, and downright disruptive to everyday life. An effective migraine plan typically includes both preventive strategies and what we call “acute rescue therapy.” Acute rescue therapy encompasses all the tools and treatments you use at the very onset of a migraine attack (or during the early stages) to rapidly lessen or abort the headache and accompanying symptoms.
In today’s post, we’ll explore the importance of timely migraine rescue in improving overall disability and preventing medication overuse headaches. We’ll also introduce the Migraine Treatment Optimization Questionnaire 5 (mTOQ-5) as a handy way to evaluate how well your rescue plan is working. Finally, we’ll discuss common lifestyle supports, non-pharmacological devices, and over-the-counter (OTC) options you can consider with guidance from your healthcare provider.
The So What
Improving Disability
Migraines aren’t just about head pain; they frequently involve nausea, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). Migraines are the second most disabling condition in the world (behind chronic back pain)! Treating the disability of migraine essentially treats the migraine. When left untreated or inadequately treated, migraine attacks can result in days of significant disability—disrupting work, family life, and personal well-being. Timely rescue therapy helps break the pain cycle early, reducing the duration and severity of attacks.Reducing Medication Overuse Headache (MOH)
Ironically, taking too much medication for migraines can sometimes worsen headache patterns over time. If you rely on frequent doses of certain analgesics or triptans, you can develop medication overuse headache—a condition characterized by chronic headaches that can be harder to treat. A well-crafted acute rescue plan aims to be both effective and used sparingly, so you don’t slip into the vicious cycle of MOH.
What does success look like?
How do you know if your current rescue therapy is working well enough? One tool that I like to use is the Migraine Treatment Optimization Questionnaire 5 (mTOQ-5). It’s quick and simple, but also demonstrates what we’re looking for with an effective plan. First, no plan is expected to be 100% reliable. A good migraine plan works more than half the time. For instance, a person might have Covid-19, and it triggers a migraine, and their typical rescues won’t help until the virus clears.
The components of the mTOQ-5 include:
Can you achieve pain freedom within 2 hours from the onset of symptoms for most attacks?
Can you plan your daily activities knowing that your migraine rescue will help if one develops during the day?
Are you able to quickly get back to life for most attacks? (which depends on your definition of quickly)
After you break your migraine, does it keep it away for 24 hours?
Are your migraine rescue therapies well tolerated?
If your results suggest sub-optimal rescue, each component can help influence the treatment plan.
Lifestyle Techniques as Part of Rescue
The next blog will discuss prescription medications, but today will discuss non-medication options.
Caffeine
Moderate caffeine intake (like a strong cup of coffee or tea) can help some people ward off a full-blown migraine if used at the earliest signs. This can be particularly useful for the brain fog and sleepiness of a migraine—especially if that’s the Most Bothersome Symptom. However, be cautious because caffeine worsens migraine for some people.Sleep
While a quick nap may provide relief for some, others find that sleeping too long or at an inconsistent schedule can trigger attacks. One interesting study looked at using high-dose melatonin with an anti-inflammatory to induce a quick nap with pain relief and found that, not only was it effective, but it was better tolerated than prescription medicines and got people back to life faster.Hydration
During an acute migraine, sipping water or an electrolyte-containing beverage can keep your blood pressure up and help prevent worsening of the migraine, especially if dehydration was a trigger for the migraine.
Essential oils
Topical peppermint oil applied to the temples or forehead can provide a cooling, soothing sensation. Some migraineurs report mild relief when used early in an attack. Using it over the forehead in the area of pain or over the temple can be useful. For headaches at the back of the head, rubbing it on the upper neck near the hairline can help soothe the region.Lavender Oil and Eucalyptus oils can also be useful, both topically and to smell. Using some principles of Traditional Chinese Medicine, if it smells good to you during a migraine feel comfortable using it. If it smells “wrong” to you, then avoid it!
Acupressure
Apply gentle pressure to specific points such as the web between your thumb and index finger (LI4 or Hegu point in Traditional Chinese Medicine) can sometimes alleviate headache intensity.
Gently massaging the temples, neck, and shoulders may reduce muscle tension that often accompanies migraines.
Devices
Several innovative devices have hit the market, offering drug-free or complementary rescue options.
Cefaly
Cefaly is an FDA-cleared external trigeminal nerve stimulation (eTNS) device worn on the forehead. It stimulates the supraorbital and supratrochlear nerves along the eyebrow by delivering small electrical impulses that can help relieve or prevent migraine pain. It’s often used daily for prevention but can also be used acutely at the start of an attack. If the migraine has progressed so that your scalp is sensitive and it hurts to brush your hair, then a Cefaly device might be more aggravating than helpful.Nerivio
Nerivio is a wireless arm device that uses remote electrical neuromodulation to help disrupt migraine pain signals. You control the intensity with a smartphone app, and sessions typically last 45 minutes. Studies have shown it can be effective for acute migraine relief.gammaCore
gammaCore is a non-invasive vagus nerve stimulator. By applying it to your neck, it stimulates the vagus nerve, potentially helping reduce the severity and frequency of migraine attacks. This hand-held device is used at the onset of migraine for acute rescue.
Over-the-Counter Medicines
OTC medications remain a staple for many people dealing with mild-to-moderate migraine attacks. Some commonly used options include:
Excedrin Migraine
Excedrin Migraine is a combination of acetaminophen, aspirin, and caffeine. The caffeine content is comparable to a small cup of coffee. Using this treatment more than 9 days per month on a regular basis (1.5 months or so) may make migraines worse. Aspirin is an NSAID, so if using this treatment, then no other medications should be taken for at least 6 hours without guidance from your health care provider.Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Ibuprofen (e.g., Advil, Motrin) and naproxen (Aleve) are effective for acute migraine relief in many cases. They help reduce inflammation and pain when taken early in an attack. Again, watch out for overuse—consistent use on more than 9 days a month can lead to medication overuse headaches.
Putting It All Together
A strong acute migraine rescue plan is one that’s multifaceted, personalized, and revised regularly. Discuss your needs with your health care provider, and think about the components of a tool like mTOQ-5 to determine if you have effective migraine rescue. Effective rescue therapy not only improves how you feel during attacks; it also limits the risk of medication overuse headache, thereby preserving the usefulness of your treatments for the long haul.
When it comes to migraines, no two people are alike. Some do best with a blend of prescription medication and lifestyle changes, while others lean on devices or quick over-the-counter options. The key is to stay open to trying new strategies, track your progress, and refine your plan. With the right combination of treatments, you can make meaningful strides in reducing your migraine disability and living life on your terms.
