What is a migraine?

A migraine is a neurological condition that causes multiple symptoms, often characterised by intense, debilitating headaches. Migraines can last for hours to days, and the pain can be so severe that it interferes with daily activities. The condition is typically divided into two main types:

Aura refers to sensations a person experiences before the migraine headache, such as visual disturbances or other neurological symptoms.

migraine aura singapore
Migraines can be accompanied by an aura, which are visual or neurological disturbances.

What causes migraines?

Migraines are believed to be caused by abnormal brain activity that affects nerve signals, brain chemicals, and blood vessels. This abnormal activity can lead to changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway in the brain. During a migraine, alterations in neurotransmitter levels, particularly serotonin, can cause inflammation and the dilation of blood vessels, which can result in the intense pain associated with migraine headaches. The exact trigger for this abnormal brain activity is not entirely understood but is thought to involve a combination of genetic and environmental factors.

What are the symptoms of a migraine?

Migraine symptoms vary widely from person to person, but typically include:

  • Severe headache: often described as throbbing or pulsating pain, usually on one side of the head.
  • Aura: an aura is a visual or sensory disturbance that precedes or accompanies the headache, such as flashes of light, blind spots, or tingling in the arms or legs.
  • Sensitivity to light and sound: many people with migraines seek relief in dark, quiet environments.
  • Nausea and vomiting: these gastrointestinal symptoms are common during migraines.
  • Dizziness or vertigo: a feeling of spinning or losing balance can occur, resulting in vestibular migraine.
  • Extreme fatigue: feeling unusually tired or lethargic, either before, during, or after the headache.
  • Mood changes: irritability or depression can be associated with migraines.
  • Difficulty speaking: some individuals may have trouble speaking clearly during a migraine, also known as aphasia.
  • Weakness: a temporary weakness on one side of the body, mimicking a stroke, can sometimes occur. This is also known as hemiplegic migraine.
migraine symptoms singapore
Migraine can leave individuals feeling drained and exhausted even after the headache subsides.

These symptoms can occur in various combinations and can last for hours to days, which may significantly impact daily activities.

Who is at risk of migraines in Singapore?

Several factors can increase the risk of developing migraines among Singaporeans:

  • Genetics: people with a family history of migraines are more likely to experience them.
  • Age: migraines can begin at any age, though they most commonly start during adolescence. The peak prevalence is in individuals aged 30 to 40.
  • Sex: women are more likely to suffer from migraines than men, possibly due to hormonal influences.
  • Hormonal changes: women may experience migraines related to menstrual cycles, pregnancy, or menopause due to fluctuations in oestrogen levels.
  • Stress: high-stress levels are a common trigger for migraine attacks.
  • Sleep patterns: both too little and too much sleep can serve as triggers for migraines.
  • Diet: certain foods and drinks, such as those containing caffeine, alcohol, aged cheeses, and processed foods, can increase the risk of migraines.
  • Environmental factors: changes in weather or barometric pressure, bright lights, loud noises, and strong odours can trigger migraines in susceptible individuals.

Understanding these risk factors can help in managing and potentially reducing the frequency of migraine attacks.

How are migraines diagnosed?

A migraine is diagnosed primarily through a clinical evaluation based on the patient’s medical history and symptoms and by ruling out other possible causes of the headache. Here are the key steps in diagnosing a migraine:

  • Medical history: your specialist will ask you about your headache history, including the nature of the pain, location, duration, frequency, symptoms, and any known triggers. A detailed family history of migraines or other headaches is also important.
  • Symptom assessment: your specialist will identify specific migraine symptoms, such as nausea, vomiting, sensitivity to light and sound, and aura (visual or sensory disturbances preceding the headache).
  • Physical and neurological examination: a physical exam will be conducted to check for signs of other conditions that may be causing the headaches. To rule out other neurological disorders, a neurological exam assesses brain function, including reflexes, coordination, muscle strength, and response to stimuli.
  • Diagnostic criteria: doctors often use the criteria established by the International Headache Society, which define specific characteristics for diagnosing different types of headaches, including migraines.
  • Imaging and tests: while there are no specific tests to confirm migraines, tests like MRI or CT scans may be used to rule out other conditions that could cause similar symptoms, such as tumours, strokes, or blood vessel abnormalities.
diagnose migraine singapore
Stress is a common trigger of migraines.

By evaluating these factors, your specialist can diagnose migraines and differentiate them from other types of headaches, which can help them develop an appropriate treatment plan.

What are the treatment options for migraine in Singapore?

Treatment for migraines aims to relieve symptoms and prevent future attacks. Treatment options for migraines include:

  • Medications for relief: pain-relieving medications, also known as acute or abortive treatment, are taken during migraine attacks to stop symptoms. These include over-the-counter (OTC) pain relievers like ibuprofen or aspirin and prescription drugs like triptans (e.g., sumatriptan), ergots, and anti-nausea medications.
  • Preventive medications: these are taken regularly, often daily, to reduce the frequency, severity, and duration of migraines. Options include cardiovascular drugs (like beta-blockers), anticonvulsants, antidepressants, CGRP (calcitonin gene-related peptide) antagonists, and botulinum toxin type A injections.
  • Lifestyle modifications: regular sleep, a balanced diet, hydration, stress management, and avoidance of known triggers can help reduce the frequency of migraines.
  • Interventional procedures: nerve blocks, botulinum toxin injections, and trigger point injections can provide relief for some individuals.

The choice of treatment is developed considering the frequency and severity of migraines, other medical conditions, and the patient’s personal preferences. Finding the most effective approach for each person is often a process of trial and error.

If you are suffering from migraines, please schedule an appointment with us for a thorough diagnosis and an appropriate treatment plan.

Frequently asked questions

Although migraines cannot be cured, they can be effectively managed with the right combination of treatments, lifestyle adjustments, and medication, which can help reduce their frequency and severity.

Migraine attacks can vary in duration, typically lasting from 4 hours to 72 hours if not treated effectively.

Yes, migraines can affect vision, often causing temporary visual disturbances known as aura, including flashes of light, blind spots, or zigzag patterns.

Yes, children can experience migraines, and they may present differently than in adults, with symptoms like abdominal pain.