Migraine
Make an AppointmentHow Are Migraines Diagnosed?
Diagnosing migraines involves a thorough evaluation by a healthcare professional, often a neurologist who specialises in treating headaches.
The diagnosis is based on your medical history, symptoms, and a physical and neurological examination.
Tests to Rule Out Other Conditions
In cases where symptoms are complex or severe, additional tests may be recommended to exclude other potential causes of headaches:
MRI Scan: Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to create detailed images of the brain and blood vessels. This test can help identify conditions such as tumours, strokes, brain infections, or bleeding.
CT Scan: Computerised tomography (CT) scans use X-rays to produce cross-sectional images of the brain. These scans are useful for detecting tumours, brain damage, infections, or bleeding that could be causing headaches.
Treatment Options for Migraines
The goal of migraine treatment is twofold: to relieve symptoms during an attack and to prevent future episodes. Treatment plans are tailored to the individual, depending on the frequency and severity of migraines, as well as other underlying health conditions. A neurologist can guide you in selecting the most appropriate treatment options.
1. Pain-Relieving Medicines
These medicines are taken during a migraine attack to alleviate symptoms. They work best when taken as soon as the symptoms begin.
- Pain Relievers: Over-the-counter options like Non-steroidal anti-inflammatory drugs (NSAIDs), eg, ibuprofen, naproxen, can help with mild migraines. Combination medicines containing caffeine, aspirin, and acetaminophen may also be effective. However, frequent use can lead to medication overuse headaches.
- Triptans: In Malaysia, prescription medications such as sumatriptan (Imitrex) block pain pathways in the brain.
- Gepants: These oral medications, such as ubrogepant (Ubrelvy), rimegepant (Nurtec ODT) and zavegepant, target specific migraine pathways and are effective in relieving pain and other symptoms like nausea and sensitivity to light. In Malaysia, only rimgepant is available.
- Antinausea Medicines: These are often used alongside pain relievers to manage nausea and vomiting associated with migraines.
- Opioids and Barbiturates: These are generally avoided due to their addictive potential and the availability of more effective options. They are only considered when other treatments fail.
2. Preventive Medicines
Preventive medications are taken regularly to reduce the frequency, severity, and duration of migraines. These are recommended for individuals with frequent or debilitating migraines.
- Blood Pressure Medicines: Beta blockers like propranolol and calcium channel blockers like verapamil are effective in preventing migraines, especially those with aura.
- Antidepressants: Tricyclic antidepressants like amitriptyline are commonly prescribed, though they may cause side effects like dry mouth and drowsiness. Other options include venlafaxine, which has fewer side effects.
- Antiseizure Medicines: Valproate and topiramate are effective for some individuals but are not recommended in women of childbearing age.
- Botox Injections: OnabotulinumtoxinA injections every 12 weeks can help prevent chronic migraines in adults.
- CGRP Monoclonal Antibodies: These injections, such as erenumab (Pasurta) and galcanezumab (Pontevia), block the CGRP chemical messenger involved in migraines. They are administered monthly or quarterly.
- Atogepant and Rimegepant: These oral medications are newer options that can both prevent and treat migraines.
Neuromodulation Therapy
Neuromodulation devices offer a non-invasive treatment option for migraines. These devices stimulate peripheral or cranial nerves to alter the brain's response to pain. Examples include:
- Transcutaneous Supraorbital Nerve Stimulation: A device worn on the forehead to stimulate nerves and reduce migraine frequency.
- External Vagal Nerve Stimulation: A handheld device applied to the neck to relieve pain.
- Single-Pulse Transcranial Magnetic Stimulation: A device placed on the back of the head to treat migraines.
Lifestyle and Home Remedies
- Rest in a quiet, dark room during an attack.
- Apply a cool cloth or ice pack to your forehead.
- Stay hydrated by drinking plenty of water.
- Practice relaxation techniques such as deep breathing or meditation.
- Maintain a regular sleep and eating schedule.
- Keep a headache diary to identify triggers and track the effectiveness of treatments.
- Engage in regular aerobic exercise, such as walking or swimming, to reduce tension and prevent migraines.
Alternative Therapies
- Acupuncture: Involves inserting thin needles into specific points on the body to relieve pain.
- Biofeedback: Teaches you to control physical responses to stress, such as muscle tension.
- Cognitive Behavioural Therapy (CBT): Helps manage stress and change negative thought patterns that may contribute to migraines.
- Yoga and Meditation: Regular practice can reduce the frequency and severity of migraines.
- Herbs and Supplements: Riboflavin (vitamin B-2), magnesium, and coenzyme Q10 may help reduce migraines, though more research is needed.
When to See a Specialist
If migraines are frequent, severe, or unresponsive to over-the-counter treatments, consult a neurologist.
At Subang Jaya Medical Centre (SJMC), our experienced neurologists provide comprehensive evaluations and develop personalised treatment plans tailored to your needs.