Headache & Facial Pain Specialist (Singapore)
Migraines - Symptoms, Causes and Treatment
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Topics:
1. What are the symptoms of Migraines? 2. What can trigger Migraine episodes? 3. Who are likely to get Migraines? 4. How does my doctor diagnose my headache? 5. What are the options for my migraine treatment? 6. What should I do if I have a migraine that does not go away? 7. How does Pregnancy affect Migraines? Headaches can be divided into two types - primary and secondary headaches. Primary headaches are not caused by an underlying health issue (eg. Migraines and Tension Headaches). Secondary headaches, on the other hand, are usually a result of an underlying health issue such as a brain tumour, spine issue or bleed in the brain. Migraine is characterized by recurrent attacks of throbbing and pulsating headache that is usually on one side of the head, lasting between 4 and 72 hours. The cause of migraines is not entirely clear but it is thought that changes in the brain and nerve signalling and blood vessel dilatation are responsible for causing the symptoms of migraine. Symptoms of Migraine:
Common triggers for migraine include:
Who are likely to get migraines?
Migraines can affect both children and adults. In adults, women are more likely to have migraines than men. These migraines can also be hormone related - some patient report having frequent migraines around the time of their menstruation. This corresponds to the changes in the hormonal levels during a woman's menstrual cycle. Apart from gender, migraines is also affected by one's genetic makeup. Many migraineurs have family members who also suffer from migraines. |
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Diagnosis of Migraine
Diagnosis of Migraine is performed largely through clinical history and examination. Although imaging is not required for the diagnosis of migraines, it should be considered if there are:
Diagnosis of Migraine is performed largely through clinical history and examination. Although imaging is not required for the diagnosis of migraines, it should be considered if there are:
- Atypical symptoms
- Changes in the headache pattern / description
- Neurological symptoms
- Systemic symptoms (eg weight loss)
Treatment of Migraine
Migraines can be treated using a variety of strategies including
Conservative treatment with:
Medications:
Abortive Medications (Medications to relieve headaches)
Preventive Medications (Medications to reduce headache days & severity)
Migraines can be treated using a variety of strategies including
Conservative treatment with:
- Napping / resting with eyes closed in a quiet and dark room
- Ice pack on the forehead
- Rehydration (especially if there is vomiting)
Medications:
- Medications for migraine can be divided into "abortive" and "preventive" medications.
- Abortive medications are taken as soon as the migraine episodes occur. The objective of these medications is to relieve the headache and restore function. See section on "Abortive Medications" below.
- Preventive medications are taken on a daily basis to reduce the frequency and severity of the migraine attacks. See section on "Preventive Medications" below.
Abortive Medications (Medications to relieve headaches)
- Over-the-counter pain medications such as Paracetamol & Ibuprofen can often be helpful for mild migraines.
- However, in more severe cases, such medications may not be adequate and prescription medications may be required. Example of prescription medications for migraine abortion includes Triptans (Sumatriptan, Zolmitriptan), Cafergot. These medications work by causing the blood vessels in the brain to narrow.
- While these medications are useful, it is important to limit the use of these medications to 2-3 times a week. Excessive use of these medications can cause "rebound headaches" in the long run. These medications should be used under the supervision of a physician.
- Migraines can commonly be associated with nausea & vomiting. If these symptoms affect you, you may also be prescribed medications to relieve these symptoms.
Preventive Medications (Medications to reduce headache days & severity)
- If you have migraine episodes more than once or twice a week, you may be started on preventive medications. These medications should be taken every day, even if you are not having a migraine. The aim of the therapy is to reduce the frequency and severity of the migraine attacks.
- These medications include:
- Medications commonly used for high blood pressure (eg. Beta-blockers, Calcium channel blockers or ACE inhibitors)
- Anticonvulsants (Medications used to treat seizures)
- Antidepressants (Medications used to treat antidepressants. However, these medications are also helpful for migraines)
- BTX Injections
- Anti-CGRP Treatments
What is Status Migrainosus?
Status migrainosus (also known as intractable migraine) is a severe and prolonged migraine attack that lasts for more than 72 hours and does not respond well to standard migraine treatments. It is a debilitating condition that can significantly impact the individual's quality of life. Status migrainosus can be challenging to manage and may require aggressive treatment strategies.
If you are experiencing Status Migrainosus, you should seek help early. Patients with status migrainosus may require hospitalization for close monitoring and aggressive treatment. Treatment for status migrainosus include the treatments mentioned above. Apart from that, you may expect the use of some of these:
If you are experiencing Status Migrainosus, you should seek help early. Patients with status migrainosus may require hospitalization for close monitoring and aggressive treatment. Treatment for status migrainosus include the treatments mentioned above. Apart from that, you may expect the use of some of these:
- IV Fluids to prevent dehydration
- IV Medications to treat Nausea / Vomiting
- IV Medications to reduce the severity of the headache
- Nerve blocks to reduce the severity of the headache
- Botulinum toxin injection
How does Pregnancy affect Migraines?
Migraines can be affected by hormone levels. For example, in female patients, migraines may worsen (or in some cases, only occur) during their periods. Pregnancy is a period that is characterized by changes in hormone levels. For this reason, many patients report improvement in their migraines. This is especially true during the 2nd and 3rd trimester. However, the migraines may recur after the pregnancy.
It is important to seek advise from your doctor if you are pregnancy for the following reasons:
Dr Christopher Liu is a Pain Specialist based in Singapore with an interest in Headaches & Facial Pain disorders. He has lectured extensively on this topic.
Migraines can be affected by hormone levels. For example, in female patients, migraines may worsen (or in some cases, only occur) during their periods. Pregnancy is a period that is characterized by changes in hormone levels. For this reason, many patients report improvement in their migraines. This is especially true during the 2nd and 3rd trimester. However, the migraines may recur after the pregnancy.
It is important to seek advise from your doctor if you are pregnancy for the following reasons:
- The medications you are taking may potentially affect the developing fetus.
- The medications you are taking may enter into your breast-milk if you intend to breastfeed after your delivery.
Dr Christopher Liu is a Pain Specialist based in Singapore with an interest in Headaches & Facial Pain disorders. He has lectured extensively on this topic.