Beyond A Headache: Understanding And Navigating Migraine

Dr Hiew Fu Liong delves into the complexities of migraines, aiming to unravel misconceptions and provide practical insights for effective management.

KUALA LUMPUR, June 26 — Migraine, often confused with a mere headache, is a condition frequently misunderstood as a mental illness.

However, it is a chronic disease with no known cure, profoundly impacting the Malaysian population. Notably, migraines disproportionately affect women compared to men.

Research indicates that approximately one in four women and one in twelve men will experience migraines at some point in their lives.

Dr Hiew Fu Liong, consultant neurologist at Sunway Medical Centre, delves into the complexities of migraines, aiming to unravel misconceptions and provide practical insights for effective management. 

Understanding Migraine

“Migraine is not just headaches; it is frequently accompanied by other symptoms like dizziness, nausea, vomiting, tiredness, photophobia, and phonophobia.

“In some cases, people may encounter some emotional aspects as well. As one of the common neurological problems, migraine is also known as a recurrent episode of severe headaches,” explained Dr Hiew. 

With migraines, there are different phases to an episode: prodrome, aura, attack, and post-drome.

“The prodrome stage is marked by subtle warning signs like malaise, fatigue, and food cravings. The aura stage involves sensory disturbances such as visual flashes or heightened sound sensitivity.

“Then, the migraine attack is a unilateral head pain and aversion to light and sound that can last from four to 72 hours. Finally, the post-drome stage follows the attack, with lingering lethargy lasting a few days,” shared Dr Hiew.

Types, Triggers, And Risk Factors Of Migraine

Dr Hiew explains the different types of migraines:

  • Migraine without aura is the most common type, characterised by sudden and severe pain typically localized to one side of the head.
  • Migraine with aura involves blurred vision or auditory hallucination often serving as warning signs preceding the onset of pain.
  • Basilar migraine presents differently from other types, with symptoms primarily involving dizziness, vomiting, and auditory hallucinations, but without the typical head pain.
  • Ocular migraine is characterised by eye pain or temporary vision loss in one eye. 
  • Catamenial migraine specifically affects women during their menstrual period, highlighting the influence of hormonal fluctuations on migraine onset.
  • Hemiplegic migraine represents one of the most severe forms of migraine, involving not only intense head pain but also paralysis on one side of the body.

Understanding the triggers and risk factors associated with migraines is crucial for patients seeking to mitigate their occurrence or reduce their frequency.

These risk factors can vary significantly from person to person and may include sudden changes in weather, dehydration, sensitivity to strong odours, caffeine consumption, exposure to loud noises, and many more. 

Dispelling Myths And Misconceptions 

Dr Hiew also addresses several common misconceptions about migraines.

“One of the most common misconceptions is people confusing a migraine and a tension type headache which complicates the diagnosis process as they have similar characteristics, thinking a migraine is psychological and it can be cured with supplements.

“This is why it’s crucial to understand that while migraine pain can be effectively managed, there is currently no definitive cure. It also has different triggers. Also, supplements alone do not treat and manage migraines,” he said. 

Treating And Managing Migraines

Given the similarity of migraine symptoms to other types of headaches, Dr Hiew notes the risk of misdiagnosis, which can result in the misuse of medications and potential complications such as gastric or kidney damage.

While there’s no cure for migraines, the goal of treatment is to manage the condition effectively. Medications are designed to ease the pain and discomfort of migraine episodes.

By consulting a neurologist, patients can develop personalised strategies to either prevent migraines or better manage their symptoms when they arise. 

“There are two treatment options that can be divided into two categories: treatment to stop the pain and treatment to prevent the migraine attacks. Pain relief treatment involves medications like painkillers while migraine prevention treatment includes anti-epileptic, anti-hypertensive, and antidepressant medications.

“There is also advanced treatment such as Calcitonin gene-related peptide (CGRP) receptor blocker that blocks CGRP receptors on trigeminal nerve responsible for communicating pain and sensitivities to touch and temperature, thus preventing migraine attacks,” added Dr Hiew.

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