Untreated migraines lead to more migraines?

October 12, 2024 11:18 AM

I recently saw a new headache specialist. While discussing medication, she told me that not treating a migraine makes it more likely that you'll get another migraine -- she said this to encourage me to treat headaches, when I said that often I'd just power through them. On reflection, this is not what I've heard from specialists before. Has anyone else been told this?

I know headaches can linger, but my impression is that she meant not treating a migraine today meant I'd be more likely to get one days / weeks / months from now. I'm hoping I misunderstood her.

posted by anonymous to Health & Fitness (9 answers total)

Failing to adequately treat episodic migraines increases the likelihood that your migraines will become chronic (defined as 15 or more headache days per month). The hypothesized mechanism is called "central sensitization" which simplified means the repeated activation of the neurons leads to them becoming more and more sensitive and easily "triggered" over time. This is a well-studied phenomenon in the research, and my specialists have referenced it as well to encourage me not to avoid treating a migraine.

It's not specifically that failing to treat one migraine today means you'll be more likely to have another migraine in the next few months, but the more that go untreated the more easily "triggered" your brain becomes, which then increases the likelihood of you having more migraines.

Here's a couple of sources on the topic, sorry I don't have anything more layperson accessible:
Central Sensitization in Migraine: A Narrative Review
Chronic migraine: A process of dysmodulation and sensitization
posted by brook horse at 11:29 AM on October 12 [22 favorites]

I was told that and it was that plus how my migraines were becoming frequent -1+ a week - that prompted me to get serious about triggers and medication for the first time. 7 years later I’ve gone from that to migraines 1-2 times a year. Anecdotal but I highly recommend not powering through them.
posted by warriorqueen at 11:58 AM on October 12 [3 favorites]

Yes. My headache specialist tells me to treat immediately.
posted by bookworm4125 at 12:03 PM on October 12 [2 favorites]

This is 100% a thing that neurologists tell migraineurs. If I can get to a migraine early before it worsens, the chances are much higher that the next day will be better. Powering through means that my head hurts for a week, to varying degrees.
posted by corey flood at 12:14 PM on October 12 [2 favorites]

Echoing above: my neurologist said treat right away - we call it the “uh-oh moment.” I was prescribed naproxen (basically four Aleve) as my first line of defense and a triptan if I didn’t have relief in 15-20 minutes. This advice changed my life!
posted by Sweetie Darling at 1:23 PM on October 12 [2 favorites]

my impression is that she meant not treating a migraine today meant I'd be more likely to get one days / weeks / months from now. I'm hoping I misunderstood her.

You have understood her correctly. My wife gets migraines and her neurologist told her the same thing, pretty much exactly as brook horse described at the top of the thread.

I'm very curious as to why you're hoping you've misunderstood her. Your specialist has given you standard medical advice and (presumably) given you drugs to treat the migraines. If those drugs don't work there are a plethora of other drugs to try. Migraines are agonising and debilitating. Why would you not want to treat them?

(this is partly a rhetorical question but equally if there is more context as to why you're asking this question people might be able to give you more nuanced answers)
posted by underclocked at 11:46 PM on October 12

Yes this is what my headache specialist told me. I have chronic migraine and have about 10-18 headache days a month. I started out with episodic migraine and my disease became chronic I believe in part because I did not appropriately treat them when I was still episodic. Now 10 days is an amazing day for me. I had a migraine that was refractory to treatment and lasted for five months. Central sensitization sucks.
posted by malum geminae at 8:44 AM on October 13 [1 favorite]

I want to make sure I’m understanding these replies correctly—does this mean that at the first sign of a headache you should take medication for it, even if that medication is just an OTC treatment like exceeding? And that doing this over time can decrease how many headaches you get long term?
posted by Amy93 at 11:20 AM on October 13

Amy93, I haven’t ever heard that it’s important to treat headaches promptly - just migraines. Most migraines cause head pain (tho not all), but most headaches are not migraines. My doctor told me to take meds at the start of the my migraine aura, at which point I typically do not have any pain.

Also, the comments are saying that not treating migraines can lead to having more migraines. That is very different than saying that treating them leads to a decrease (unfortunately!).
posted by maleficent at 11:41 AM on October 13 [2 favorites]