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Early Intervention in Migraine Attacks: Making Sense of the Data
James Adelman, MD and Marshall Freeman, MD
Posted: October 2005  
Headache & Pain 2005;16(3):109-115

Background:  The goal of early intervention in acute migraine is to treat before central sensitization develops. Recent studies suggest that a therapeutic plasma level of triptan must be achieved within 30 to 120 minutes after the onset of pain to maximize treatment outcome. Initial reports of triptan use during the early stage of a migraine attack are confusing because different study populations, methods of analysis, and definitions of "early treatment" were used.

Objective:   We have reviewed the data on early intervention. The reports are divided into 3 groups: a) retrospective analyses of double-blind, placebo-controlled, randomized clinical trials; b) open-label studies; and c) double-blind placebo-controlled trials with "early" treatment.

Summary:  Triptan use in the early stages of a migraine attack appears to result in favorable outcomes at almost twice the rate of delayed treatment during moderate/severe migraine pain.