Migraines can be headaches to deal with, affecting one in ten people globally . But what are they? How do you treat migraines in Singapore? If you’re curious to understand more about these dreadful headaches, read on for the definition of migraines, major risk factors, classical features of migraines, and more! :
- Definition of Migraines
- Major Risk Factors
- Classical Features of Migraines
- Common Symptoms and Why they Happen
- Migraine Triggers
- Lifestyle Changes
- Current Medical Management
- New Therapeutic Drugs
What are Migraines?
Migraines are throbbing headaches that impair your ability to participate in daily activities .
They last anywhere from four to 72 hours and can affect one or both sides of your head. Other symptoms of a migraine include:
- Photophobia: Inability to tolerate bright lights
- Phonophobia: Inability to tolerate loud noises
Why do migraines occur?
Migraines are brought about by a complex interaction of environmental and genetic factors but the exact causes remain unknown .
- Family History
- High BMI
- Age: Migraines are likely to reach their peak in the 30s
- Gender: Females are 3 times more likely than males to suffer attacks
- Menstrual Cycles: Some may experience a link between their monthly menstruation and migraine attacks with the latter receding in frequency or intensity during pregnancy and menopause
What happens during a migraine?
There are 4 classical stages of migraines:
This phase happens up to the day before the onset of the headache where you may experience :
- Mood changes
- Excessive yawning
- Muscle aches
The aura phase takes place about 30 minutes to an hour before the headache. You may experience reduced or loss of sensation to different body parts, visual changes and problems with speech and swallowing .
The headache itself may last from 4 to 72 hours and is characterised by throbbing on one or both sides of the head. It can also be accompanied by nausea, vomiting and other symptoms .
After the headache, you may still feel under the weather and experience lethargy, muscle aches and cognitive changes .
As every individual is different, migraine episodes do not always present themselves in exactly the same way.
These lists of common symptoms are therefore not exhaustive.
Some may even be diagnosed with migraines by doctors even without experiencing the stated classical phases above .
What are some common headache symptoms?
Researchers have linked common symptoms experienced in migraines to dysfunction in certain areas in our brains.
Different regions in our brain communicate with one another via nerve signals to enable us to function smoothly. Think of it as an office building with many different departments, each with a particular set of tasks to accomplish .
Migraines disrupt the communication lines both within and between specific regions of the brain causing increased sensitivity.
These dysfunctional communications were picked up by researchers using medical imaging techniques .
The Hypothalamus, for example, is a small round structure that sits at the base of our skull .
The function of the hypothalamus is to maintain a stable internal body environment which helps regulate :
- Normal Sleep-Wake Cycle
- Body’s fight or flight system
- Both mental and physical states of the body.
Consequently, when hypothalamus functioning is disrupted during a migraine attack, you experience symptoms like yawning, lethargy and mood swings .
If you experience:
- Facial flushing
- A stuffy nose
It is likely the hypothalamus has activated the body’s ‘Flight’ system .
The altered nerve function can also result in pain caused by sensory stimuli such as combing hair or having a shower that usually feels normal.
What triggers a Migraine?
Certain triggers can bring on migraine episodes. Lifestyle changes to minimize exposure to triggers may be helpful in reducing migraine frequency.
Below is a non-exhaustive list of common triggers :
- Oral Contraceptive Pills
- Lack of Sleep
- Make sure you are well rested every night
- Exercise for at least 30 minutes three times a week
- Eat healthy, balanced meals with minimal or stable caffeine consumption
- Stay hydrated throughout the day
- Try to reduce stress levels with activities like relaxation sessions, mindfulness or approach your doctor if you feel that cognitive behavioural therapy may help with your anxiety.
What relieves migraine pain fast?
If you are experiencing discomfort with bright lights or loud noise, moving to a quiet dark room may alleviate your headache.
Medications are best taken once the migraine begins. Based on the severity of your migraines, your doctor may prescribe some of these medications :
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs help relieve pain and shorten migraine episodes. Ibuprofen, Naproxen, Diclofenac and Aspirin are all examples of NSAIDs . These medications can be very harsh on stomach linings and a doctor may prescribe additional medication to protect the stomach.
- Oral Tablets
- Subcutaneous Injection
- Intra-nasal Spray
The subcutaneous injections work the quickest but have a higher risk of side effects.
Intra-nasal sprays are the second fastest to take effect followed by oral tablets. How it is administered depends on how severe your migraine attack is and how quickly you need the medication to take effect.
This is usually a decision made by you and your doctor. 
During a migraine attack, arteries in the brain produce a protein that causes inflammation and pain.
Triptans medications decrease blood flow to these arteries and normalise the levels of inflammatory proteins in the nervous system .
These are a group of medications that will help prevent nausea and vomiting. Metoclopramide, Prochlorperazine, and Domperidone are some examples of anti-emetics. 
Metoclopramide can be administered via:
- Oral Tablets
- Intramuscular Injection
- Intravenous Drip
Similar to triptans, how the medication is administered is dependent on how severe your migraine attack is and how quickly you need it to take effect.
Ergotamines have been mostly replaced by the use of triptans. However, patients who suffer from side effects from triptans may be put on these medications.
This group of medications can be administered in 2 ways:
- Rectally (This is only done in certain countries)
What are the Side effects and Contraindications of NSAIDs, Triptans, Anti-Emetics, and Ergotamines?
Ulceration or bleeding in the stomach
Kidney, Liver, or Heart problems
Raised blood pressure
Increased pressure sensation on the chest and neck area
Coronary artery disease
Uncontrolled high blood pressure
Decreased heart rate,
High blood pressure.
A disease of your adrenal glands called pheochromocytoma.
Increased blood pressure
High blood pressure
Other problems with your circulation
Liver or Kidney disease.
*Contraindications to a medication refer to specific circumstances in which the medication should not be used. Side effects and contraindications listed here are non-exhaustive .
What are medication overuse Headaches?
If you have worsening headaches despite regular medication, you may be suffering from medication overuse headaches. Medication overuse is currently defined as:
- Using NSAIDs or paracetamol for 15 days or more per month .
- Using Ergotamines, Triptans, Combination of Analgesics or Opioids for 10 days or more per month for at least 3 months .
Your doctor may advise withholding medication or reducing the quantity of medication taken. During this time your headaches may become worse before improving .
It is common to experience withdrawal symptoms such as :
- Nausea and Vomiting
- Difficulty Sleeping
These may last for up to 2 weeks and it is important to consult your doctor to care for you through this process .
What can I do to prevent a Migraine Attack?
Preventative treatments not only shorten the duration and reduce pain, but they also work to decrease the number of attacks.
Unlike the medications elaborated on earlier, preventative medications need to be taken regularly even in between migraine episodes. 
Preventative treatments are considered in patients who experience at least 3 migraines per month. 
Your doctor may advise you to keep a diary of your migraine attacks to assess the success of the treatment. If no improvement is seen, you may be asked to stop these medications. 
The following medications are used in preventative treatment:
Medication Group 
Individual Names of Medications 
Side Effects 
Reduced exercising capacity
Patients with Asthma,
Low blood sugar (Those on certain diabetes medications)
Heart conduction problems
- Increase in weight
- Dry mouth
Switch to other medications if side effects become an issue
- Sodium Valproate
- Poor focus
- Patients who are planning to conceive
Side effects and contraindications listed here are non-exhaustive.
How else can I get treated for Migraines in Singapore?
Treatment choices for migraine have grown over the last few years. Novel treatment modalities include:
- Calcitonin Gene-Related Peptide
- Botox Injections
The complexity of migraines means that each patient responds differently to different treatments.
If you have tried different migraine treatments and none of them has done the trick for you, your doctor may suggest you try these newer treatments.
1. Calcitonin Gene-Related Peptide
This novel therapy targets a protein released during migraine episodes. The protein, called Calcitonin Gene-Related Peptide (CGRP), causes inflammation and pain in the protective coverings of the brain.
Older medications like triptans reduce the amount of CGRP in the brain.
These novel therapies work differently and do not decrease the levels of CGRP but instead render them inactive in the body .
Erenumab is an example of this novel drug that has been approved in Singapore.
These drugs are an improvement over current medications because they are administered as monthly injections instead of daily tablets .
2. Botox Injections
Onabotulinum A (Botox) injections ease muscle tension. They block nerve signals, resulting in reduced pain levels and decreased inflammation .
This treatment involves injections into multiple sites around your head and down to your neck every 3 months. It has been approved for preventative treatment.
As it takes a few days before it kicks in, they do not play a role in the management of migraine attacks after they have begun.
As always, treatments come with their side effects. Botox Injections are generally safe but if too much is given it can result in muscular weakness and there is also a chance of swellings at the injection site [6,18].
Where can you go for Migraine Treatment in Singapore?
Most migraine medications can be prescribed to you by your General Practitioner (GP). If you are experiencing particularly severe migraines or a headache that differs from your usual headache pattern, you should consider visiting the A&E department for a full assessment.
Migraines are complex headaches that are still not fully understood. However, there are many options for you to help reduce the pain and frequency of your migraine attacks! We hope that this article has given you a comprehensive overview of how your condition can be managed.