Migraine and Headache Treatment and Management
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Key Takeaways
- A migraine is a severe headache that causes throbbing, pulsing pain on one or multiple sides of your head or body.
- A migraine comes in various types, with some exhibiting additional symptoms that indicate that a migraine will occur.
- Migraines affect people differently, with some experiencing them rarely while others experience them more frequently or with greater intensity.
- Migraine treatments are provided via prescription medications and lifestyle changes to reduce the risk of future migraine attacks.
What is a Migraine?
A migraine is a severe headache characterised by a throbbing, pulsing pain on one (or, rarely, both) side(s) of your head or body. This condition affects children, teenagers, and adults, and may last anywhere from a few hours to a few days. In some instances, a migraine can be so severe that it could affect a person’s ability to carry out their daily schedule. The whole-body experience of a migraine can make you feel sluggish, nauseated, and generally uncomfortable.
Migraines tend to occur more frequently in women than in men. While not curable, migraines are treatable, though the types of therapies needed may differ from one person to another.
What are the Types of Migraines?
Migraines are divided into several types, each exhibiting variations in symptoms, intensity, and associated complications.
Classic Migraines
These migraines typically feature an aura, a phase that occurs just before or during a migraine. Experiencing an aura tends to signify that a migraine is approaching, allowing time to take appropriate measures.
There are three types of auras:
- Visual auras: These cause temporary changes in vision, such as flashes of light.
- Sensorimotor auras: You may experience tingling sensations or even numbness or weakness in your limbs.
- Dysphasic auras: You may experience slurred speech or other verbal or language changes.
Common Migraines
Common migraines occur without a prior aura manifesting, making them far less predictable than classic migraines. As such, they may happen at any time while you are busy with work, play, or other activities.
Episodic Migraines
Episodic migraines occur very infrequently, typically meaning you experience migraine symptoms for less than 15 days a month.
Chronic Migraines
A chronic migraine is defined as occurring on at least 15 days per month, where at least eight of these days have migraine symptoms, for at least three months.
Hemiplegic Migraines
A hemiplegic migraine may cause temporary weakness on one side of your body, along with other symptoms like temporary vision changes, dizziness, or speech difficulties.
Other Migraines
Some migraine types may also be characterised based on triggers, specific conditions, and severity. For example, a refractory migraine is a variant of a chronic migraine where conventional treatments are unable to treat the symptoms.
Causes of a Migraine
The exact cause of a migraine is still being researched. Studies indicate that migraines stem from abnormal brain activity that overstimulates nerves, triggering a cascade affecting multiple brain regions, though the root cause remains unknown. This neurological condition may then affect your nerve pathways, chemicals, and blood vessels in the brain, releasing inflammatory substances that sensitise nerves inside your skull and cause symptoms of a migraine attack.
Certain triggers may cause a migraine to manifest, and triggers may vary from person to person. For example, a person may experience migraines if they do not consume sufficient food or drink or if they are stressed at work. Orthopaedic conditions may also be a migraine trigger, as they may put pressure on nearby nerves that cause pain that travels to the head, manifesting as a migraine. Even some foods are said to be migraine triggers, such as chocolate, dairy, processed foods, and certain fruits (like avocados).
It is also known that migraines have a genetic component, so you may be at risk of migraines if a family member also has the condition.
Migraine Symptoms
Migraine symptoms occur through four different stages. However, each person experiences symptoms differently, and you may not experience symptoms through all four migraine stages.
Prodrome
Prodrome symptoms occur one or two days before a migraine, and tend to be subtle.
- Mood changes
- Difficulty concentrating
- Frequent yawning
- Sleep difficulties
- Fatigue
- Nausea
- Increased urination
Aura
An aura may manifest just before or during a migraine. They may begin gradually, then build in intensity.
- Vision changes (vision loss, flashes of light, bright spots, etc.)
- Pins-and-needles sensations in your limbs
- Weakness/numbness on one side of your face
- Ringing in your ears (tinnitus)
- Sensitivity to touch
- Difficulties communicating
Migraine Attack
This phase is when the migraine occurs, lasting several hours or until you receive treatment.
- Intense, pulsing/throbbing headaches
- Increased nausea
- Vomiting
- Chills
- Heightened sensitivity to light, sound, and touch
- Increased pain when moving or performing activities
Postdrome
The postdrome represents the aftermath of a migraine, with symptoms lingering for some time after the migraine has gone away.
- Feeling drained and confused
- Fatigue
- Brain fog
- Dizziness
- Mild nausea
- Pain from sudden head movements
- Neck pain
How is a Migraine Diagnosed?
A migraine does not have specific diagnostics to detect its presence, so doctors will use a combination of methods to confirm if you have a migraine or otherwise.
Physical Examination
A physical exam allows a doctor to check for migraine symptoms. They may also review your medical history and ask questions related to your health, including the frequency of headaches and whether you have a family history of migraines. It is essential to provide as much information as possible to the doctor so they can obtain a clear diagnosis of your condition.
Neurological Examination
A neurological examination is performed to assess the health and function of your brain and nervous system. It may help to determine the cause of your migraines and inform the treatment plan accordingly. The exam may assess your cognition, reflexes, and perception to specific stimuli, such as touch and sound.
Imaging Tests
Imaging tests may be performed to obtain a more accurate diagnosis and to rule out other conditions that may be causing your pain.
CT Scans
Computerised tomography (CT) scans rely on X-rays to create detailed cross-sectional images of your brain to diagnose possible causes of your migraines.
MRI scans
Magnetic resonance imaging (MRI) scans use magnetic fields and radio waves to create detailed images of your brain and surrounding blood vessels, looking for more specific warning signs.
Management and Treatment for a Migraine
While there is no cure for migraines, treatment and management options are available to manage them.
Physical Therapy
Physical therapy may be recommended if the cause of your migraine stems from musculoskeletal issues, such as pain in your jaw, neck, or shoulders. A physiotherapist can teach you gentle exercises to reduce tension, stiffness, and weakness in specific areas of your body. You may also receive guidance on the correct sitting and standing posture to reduce tension and minimise pressure on nerves.
Acute Medication Treatment
These medications are prescribed to treat symptoms during a migraine attack. They are ideally taken as soon as symptoms start, while they are still mild. These range from painkillers, such as ibuprofen and aspirin, to anti-sickness medicines (anti-emetics) that help you cope with any sickness you may experience during a migraine. These anti-sickness medicines can be taken to allow your body to absorb painkillers, as your gut’s absorption reduces during a migraine attack.
There are also triptans, which are prescription medicines that block pain pathways in the brain to relieve migraine symptoms. Triptans may be recommended if painkillers and anti-sickness medicines do not relieve symptoms, or in combination with these medications. However, you may not be able to take triptans if you are at risk of certain conditions, such as heart disease or stroke.
If you experience nausea and vomiting, anti-nausea medications may help relieve these symptoms and can be taken together with painkillers.
Preventive Medication Treatment
Also known as prophylactics, these medications are taken to prevent migraine attacks from developing. They are prescribed to people who have frequent migraine episodes to reduce the frequency and intensity of migraines. Some preventive medications include:
- Antidepressants
- Anti-seizure medications
- Beta blockers
- Calcium channel blockers
- Gepants
Your prescription will largely depend on factors such as your health, any preexisting conditions, and the side effects of the medications you take.
Lifestyle Changes
Modifying your lifestyle may help you avoid migraine triggers or reduce the frequency of migraines. Your doctor will help you identify your triggers and recommend ways to avoid them, which may include seeking professional help with managing stress and other triggers. You may also be asked to include the following in your daily schedule:
- Try relaxation techniques to manage your stress levels. Regular meditation and journaling sessions may help prevent migraines.
- Stay hydrated at all times, especially if dehydration is a migraine trigger.
- Maintain a consistent sleep and eating schedule. Ensure you always receive sufficient nutrition and rest daily to minimise the risk of migraines.
- Exercise regularly to keep fit. Always start with warm-up sessions beforehand to reduce the risk of a migraine from sudden movements.
- Record your symptoms, triggers, and other relevant information in a migraine journal. It may help your doctors fine-tune your treatment plan and minimise the frequency and intensity of migraines.
- Gently massage your scalp and temples if you feel a migraine coming on. This may help to provide some relief for mild migraines.
- If permitted, consider taking supplements to boost your intake of essential vitamins and minerals.
When Should You Seek Migraine Management?
Migraines affect people differently, so you should seek professional migraine management support if you have been experiencing frequent and intense migraine episodes. If the migraines are getting in the way of your daily activities, it is best to seek help immediately. Seeking care immediately also serves as a preventive measure, reducing your risk of stroke while ensuring you can continue your daily activities without difficulty.
Headache and Migraine Specialist in Singapore
Dr. Hope Ang
MBBS (NUS) | MMed (Anaes) | FAMS
Dr Hope Ang is a Consultant Anaesthesiologist with extensive expertise in acute and chronic pain management, dedicated to helping patients regain function, reduce suffering, and improve quality of life through evidence-based, personalised care.
With more than 18 years of clinical experience, Dr Ang specialises in the assessment and treatment of complex chronic pain conditions, including musculoskeletal pain, neuropathic pain, cancer-related pain, and persistent postoperative pain. His approach integrates interventional pain procedures, ultrasound-guided regional techniques, multimodal pharmacological strategies, and close collaboration with multidisciplinary care teams to address both the physical and functional impact of chronic pain.
Frequently Asked Questions About Headache and Migraine Treatments
A headache is a symptom of a migraine, and it may also occur with other conditions. Frequent headaches do not necessarily indicate a migraine, so a medical consultation is necessary to identify the root cause and inform your treatment plan.
No, but treatments can help to minimise the risk of migraines. Some migraines do go away on their own, but more severe ones may last a significant time and require prompt treatment to address.
According to the World Health Organisation (WHO), a migraine attack is classified as a “headache disorder,” which is considered disabling. Per statistics in 2021, migraines are said to be the “third-highest cause of disability-adjusted life years” globally, as they can be burdensome to people by interrupting their lives and activities.
