Understanding and Navigating Migraine with a Consultant Neurologist

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HIEW FU LIONG
Consultant Neurologist
Sunway Medical Centre

Migraine is often mistaken for a simple headache or even misunderstood as a mental illness. However, it is a chronic neurological disease that has no known cure.

It significantly affects a large portion of the Malaysian population. Research shows that migraines disproportionately impact women more than men, with 1 in 4 women and 1 in 12 men experiencing migraines at some point in their lives.

WHAT IS MIGRAINE?

“Migraine is not just a headache; it is frequently accompanied by other symptoms like dizziness, nausea, vomiting, fatigue, sensitivity to light (photophobia), and fear of loud sounds (phonophobia),” explains Dr Hiew Fu Liong.

He adds that migraines can also involve emotional aspects and are known as recurrent episodes of severe headaches.

MIGRAINE EPISODES TYPICALLY PROGRESS THROUGH 4 PHASES
  1. Prodrome. Subtle warning signs such as malaise, fatigue, and food cravings.
  2. Aura. Sensory disturbances like visual flashes or heightened sound sensitivity.
  3. Attack. Intense, unilateral head pain coupled with aversion to light and sound, lasting from 4 to 72 hours.
  4. Post-drome. Lingering lethargy that may persist for a few days
THERE ARE A FEW TYPES OF MIGRAINES

Dr Hiew identifies several types of migraines:

  • Migraine without aura. The most common type, characterized by sudden and severe pain localized to one side of the head.
  • Migraine with aura. Accompanied by blurred vision or auditory hallucinations, often serving as precursors to pain.
  • Basilar migraine. Primarily involves dizziness, vomiting, and auditory hallucinations without the typical head pain.
  • Ocular migraine. Involves eye pain or temporary vision loss in one eye.
  • Catamenial migraine. Affects women during their menstrual period, indicating a link to hormonal fluctuations.
  • Hemiplegic migraine. A severe form that not only includes intense head pain but also paralysis on one side of the body.
UNDERSTANDING THE TRIGGERS & RISK FACTORS IS ESSENTIAL TO MANAGE MIGRAINES

Triggers can include sudden weather changes, dehydration, sensitivity to strong odors, caffeine consumption, and exposure to loud noises, among others.

HOW MIGRAINE IS TREATED & MANAGED

The primary goal of migraine treatment is to manage the condition effectively. By consulting a neurologist, patients can develop personalized strategies to either prevent migraines or better manage their symptoms.

“There are two main treatment options: one to stop the pain and another to prevent the migraine attacks,” notes Dr Hiew.

Pain relief treatments include painkillers, while preventive treatments involve anti-epileptic, anti-hypertensive, and antidepressant medications.

Advanced treatments, such as calcitonin gene-related peptide (CGRP) receptor blockers, are also available, targeting the trigeminal nerve to prevent migraine attacks.

Must-Know Migraine Facts & Hacks from a Consultant Neurologist

WORDS LIM TECK CHOON

FEATURED EXPERT
DR JULIA SHAHNAZ MERICAN
Consultant Neurologist
Prince Court Medical Centre
DR JULIA SHAHNAZ BOILS DOWN MIGRAINE INTO 6 SIMPLE-TO-UNDERSTAND POINTS
  • It causes moderate to severe throbbing headaches that between 4 and 72 hours. These headaches can affect the back of the head and neck or around the eyes.
  • It is frequently accompanied by symptoms such as nausea, vomiting, dizziness, sensitivity to light (photophobia), and/or sensitivity to loud noise (phonophobia).
  • The headache is typically made worse by movement or activity. Most people with migraine tend to avoid routine physical activities because of this.

A summary of migraine symptoms. Click on the image for a larger, clearer version.

  • Many people that develop migraine have family members that also have migraine; family history is one of the main risk factors of this condition.
  • Women are more susceptible than men.
  • Sometimes, children as young as 5 may begin having recurrent abdominal pain called abdominal migraine, only to start to experience typical migraine headaches at puberty or early adulthood.
DO YOU HAVE MIGRAINE?

Dr Julia offers three questions. If you answer “YES” to at least 2 of these questions, there is a chance that you have migraine and should consult a doctor.

  1. Has a headache limited your activities for a day or more in the last 3 months?
  2. Are you nauseated or sick to your stomach when you have a headache?
  3. Does light bother you when you have a headache?

The medical specialist that can help treat migraine is the neurologist.

KEEP A HEADACHE DIARY

Dr Julia recommends keeping a headache diary.

The diary can be a physical journal, a monthly calendar, or one of many smartphone apps available.

Record the following:

  • The number of monthly migraine days—the most important information for a doctor to advise on treatment strategies.
  • Days when headache medications are taken—helps to spot whether your headaches may also be caused by overuse of medications (‘medication overuse headaches’).
WHAT’S NEW IN MIGRAINE TREATMENT?

Dr Julia reveals that researchers have found that during a migraine, the brain is flooded by various chemicals released by nerves and blood vessels, including calcitonin gene-related peptide antibodies (CGRP).

Thus, some of the most recent treatments target the production of CGRP in order to reduce both the frequency and intensity of migraine attacks significantly.

New Treatment for Both Acute Treatment of Migraine and Prophylactic Treatment of Episodic Migraine Now Available!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR JULIA SHAHNAZ MERICAN
Consultant Neurologist
Prince Court Medical Centre

Recently, pharmaceutical company Pfizer Malaysia announced the availability of NURTEC™ (rimegepant) in Malaysia.

WHAT IS IT FOR?

Well, it’s a prescription medication designed to treat acute migraine and prevent migraine attacks.

MORE ABOUT MIGRAINE

Dr Julia Shahnaz Merican shares that migraine can present itself with or without aura.

Those suffering from migraine with aura tend to experience visual disturbances such as dots, sparks or zigzags before a migraine attack.

These visual disturbances are absent in migraine without aura, which is the more common type of migraine.

“Regardless of the type, migraines significantly disrupt one’s quality of life, often forcing patients to seek solace in a dark room until the pain and symptoms subside,” Dr Julia says.

HOW DOES THIS MEDICATION WORK?

“While the exact cause of migraine remains a mystery, over the past 30 years, clinical and preclinical studies have investigated the role of a neuropeptide called calcitonin gene-related peptide (CGRP) in migraine occurrence,” Dr Julia reveals.

NURTEC™ works as a CGRP receptor antagonist.

What this means is that it can act to block the effects of CGRP, thus helping to provide pain relief during migraine attacks.

Furthermore, this medication has received approval for use in reducing the frequency of future migraine attacks when used preventively.

NURTEC™ is for oral use and is currently available in Malaysia. It is a prescription medicine, which means you will need a doctor’s prescription to obtain it. If you believe that you may benefit from this medication, please discuss this matter further with your doctor.

Reference: Pfizer Malaysia Sdn Bhd. (2024, January 18). NURTEC™ (rimegepant) is now available in Malaysia for both acute treatment of migraine and prophylactic treatment of episodic migraine [Press release, KKLIU 0244 / EXP 15.07.2024].