Do you sometimes experience severe types of headache that don’t go away with painkillers? You might have a migraine. We ask neurologist DR FONG KA YEUNG about migraine symptoms, triggers and how to tackle the pain with treatments for migraines.
What is migraine? How does it differ from other types of headache?
A common headache is also known as a tension headache; it’s often described as a dull, aching pain or pressure around the forehead, temples or the back of the head. It consists of a band-like constriction around the forehead, and is usually relieved by taking painkillers. Migraine is more severe and usually characterised by a unilateral throbbing headache associated with nausea, vomiting and sensitivity to light, sound and smell.
How and why does someone get migraines?
There are numerous factors that could trigger migraines – lack of sleep or oversleeping is the most common reason. During holidays, office workers may try to catch up on sleep, for example – this can trigger migraine attacks. Another common triggering factor is food. Some patients may experience migraines after consuming chocolate, cheese or monosodium glutamate (MSG). Sunbathing, women taking contraceptive pills, and exercising under the sun can also all contribute to the onset of migraine.
Who is more likely to have migraine? Is it hereditary?
Migraine is a distinct neurological disorder typically affecting around 12.5 percent of the population. It’s more prevalent among women due to hormonal influences, usually by a factor of about two to one, particularly those in their reproductive age between 15 and 45. Migraines run in families too; having a family member suffer from these intense pounding types of headaches would put you in a higher risk category – around 10 to 15 percent of migraine patients have a hereditary link to the disorder.
How are patients affected by migraine symptoms? For instance, how often do they get them?
Migraine can be divided into two categories: classical migraine and common migraine. Classical migraine is preceded by a visual aura that might consist of bright shimmering lights or the centre of the visual field being obscured. These migraine symptoms may last for half a minute to several minutes. For a patient who suffers from common migraine, vision won’t be affected but they will have all the other characteristics of migraine.
A patient who suffers from a high-frequency episodic headache or chronic migraines will have a high number of attacks, causing a severe impact on their activities and daily life. Particularly, for chronic migraine sufferers, at its worst, half of the days in a month could be plagued by migraine, and the symptoms of each could last for 24 to 48 hours.
So how can we treat and prevent migraine?
Migraines can strike at any time. The treatment of migraine includes acute treatment and preventive treatment. A migraine is not one of the usual types of headache; when it occurs, patients might need to take a combination of painkillers, including aspirin, paracetamol and caffeine to terminate the migraine attack. However, some patients may not find relief even after taking painkillers; instead, they may need to use migraine specific painkillers known as gepants and triptans, which are prescribed by doctors.
When it comes to high frequency episodic headache or chronic migraine, preventive treatment is indicated. Over the years, patients may come to rely on medications like antidepressants, anticonvulsants or antihypertensives for prevention. However, these drugs are “borrowed” from the treatment of other diseases; they’re not specifically targeted towards migraine.
Can adverse effects arise from depending on painkillers to treat migraine symptoms?
If a migraine patient takes painkillers for an extended period, they may develop a tolerance and require an increasing dosage over time. Additionally, this can contribute to medication overuse headaches, also known as rebound headache – in these cases, taking painkillers might cause more headaches, and they can be even worse. This is why both acute and preventive treatment of migraine are important in migraine management.
What’s new in the treatment nowadays?
One advance has been the emergence of what are known as CGRP receptor antagonists, which have been specifically developed for migraine. These can be given by injection or taken orally. This treatment has a specific mechanism and a higher efficacy in both acute and preventive treatment – and fewer side effects have been observed. Compared to conventional treatment of migraine, it’s also been found that the compliance is higher. Some patients have experienced a reduction in the frequency of their headache attacks from 20 times a month to only one or two times.
When a migraine comes on, what’s the best way to ease or reduce the pain?
A patient should take painkillers as soon as possible. This is because if the migraine leads to nausea and vomiting, taking a painkiller may not be helpful or effective. If medicine is unavailable, they can try finding relief by taking a nap in a dark room. This can also help to alleviate the headache.
For long-term migraine management, the most effective method is to make lifestyle changes, such as reducing stress, engaging in regular exercise, getting plenty of sleep and so on. However, in cases where lifestyle changes alone are insufficient, individuals may need to consider taking preventative medications to reduce the frequency and severity of migraine attacks. It’s recommended to consult with a healthcare professional to explore the available options and determine the most suitable approach.
The above information about types of headache, migraine symptoms and treatment of migraine is provided by Dr Fong Ka Yeung.
