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.

IHH Healthcare Malaysia Pioneers the Use of Solar Power Across Its Entire Hospital Network

WORDS LIM TECK CHOON

On 29 April 2024, IHH Healthcare Malaysia launched a comprehensive renewable energy initiative across its network, becoming the pioneer private healthcare provider in the country to transition to solar power through the installation of solar panels at its hospitals.

This initiative is a strategic partnership with Ditrolic Energy.

A COMMITMENT TO SUSTAINABILITY & RENEWABLE ENERGY

The event was officiated with the energization of the solar panels of the Prince Court Medical Centre by Yang Amat Berhormat Dato’ Sri Haji Fadillah Haji Yusof, the Deputy Prime Minister of Malaysia and the Minister of Energy Transition and Water Transformation (PETRA).

Dato’ Sri Haji Fadillah said: “IHH Healthcare’s initiative is a significant milestone towards Malaysia’s commitment to sustainability and renewable energy. It aligns perfectly with our national goals to increase the use of renewable energy and achieve net-zero greenhouse gas emissions by 2050.”

ROLLOUT ACROSS ALL IHH HEALTHCARE MALAYSIA HOSPITALS BY 2025

Other IHH Healthcare Malaysia hospitals with energized solar panels include Gleneagles Hospital Penang, Pantai Hospital Laguna Merbok, Pantai Hospital Klang, Pantai Hospital Cheras, Pantai Hospital Kuala Lumpur, Pantai Hospital Ampang, and Pantai Hospital Batu Pahat.

Jean-François Naa, the Chief Executive Officer of IHH Healthcare Malaysia, said: “We acknowledge that energy consumption is our largest source of direct greenhouse gas emissions, accounting for over 75% of our carbon footprint. With the installation of solar panels across our network of hospitals, we are able to transition to renewable energy and reduce our greenhouse gas emissions.”

Full rollout of solar power across IHH Healthcare Malaysia hospitals is expected to be completed by 2025.

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].

What Happens When Your Prostate Gland Becomes Enlarged? Find Out from A Consultant Urologist

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre
BENIGN PROSTATIC HYPERPLASIA (COMMONLY ABBREVIATED AS BPH) IS A NON-CANCEROUS ENLARGEMENT OF THE PROSTATE GLAND COMMONLY OBSERVED IN OLDER MEN
An overview of benign prostatic hyperplasia. Click on the image for a larger, clearer version.

This condition has become more common due to several factors including:

  • Changes in men’s attitude towards their health and well-being. These changes in attitude led to them seeking medical advice more proactively.
  • Advancements in healthcare have led to a longer lifespan seen among men. Because of this, there is an increase in the number of elderly individuals and consequently has a rise in the incidence of benign prostatic hyperplasia.

By the age of 50, about 50% of men experience prostate enlargement, and this figure rises to about 80% by the age of 80.

This highlights a significant correlation between age and the prevalence of benign prostatic hyperplasia.

COMMON SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA
Seek medical attention when you experience any of these symptoms over a long period of time or when they interfere with your daily routines.
  • Frequent trips to the restroom
  • A need to wake up from sleep to urinate (nocturia)
  • Weak urine flow
  • Painful urination
  • Blood in the urine
  • A feeling of incomplete bladder emptying
  • Symptoms of more advanced stages of benign prostatic hyperplasia can include high fever and/or an inability to urinate.
SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA CAN WORSEN OVER TIME

This is especially true as individuals age and potentially encounter other health problems that can worsen their prostate issues, such as diabetes and stroke.

However, if one’s underlying health issues are well-managed and infections are treated effectively, there is potential for improvement in the prostate condition.

AVAILABLE TREATMENT OPTIONS FOR BENIGN PROSTATIC HYPERPLASIA

Treatment involves a comprehensive approach for managing any underlying conditions and considering the extent of the enlargement and its impact on the patient.

If the prostate enlargement is minimal, usually we will monitor for the time being for any further enlargement.

However, if symptoms cause significant discomfort, the doctor will prescribe the appropriate medications to manage these symptoms.

If medications are not effective, we can consider surgery. There are several surgical options to consider, depending on individual circumstances and preferences.

LIFESTYLE & SELF-CARE MEASURES TO MANAGE THE SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA
  • Adopt a lifestyle regimen that includes reducing the intake of irritants like caffeinated beverages—these irritants can increase the urge to urinate.
  • Reduce consumption of liquids and foods high in water content during the evenings, to help avoid nighttime bathroom visits.
  • Maintain proper hygiene to prevent infections, especially since prostate enlargement increases one’s risk of infection.
TIPS TO REDUCE ONE’S RISK OF BENIGN PROSTATIC HYPERPLASIA

Benign prostatic hyperplasia is associated with ageing. Good habits as above could prevent worsening of the condition.

Additionally, one should seek regular medical check-ups, such as blood and urine tests, to monitor kidney function and identify potential infections early.

A Consultant Urologist Talks about Kidney Stones & How They Affect Children & Younger Adults

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

Kidney stones are formations that develop in the kidney.

The process of stone formation often begins with a blood flow issue. Such issue causes a small crystal to start to grow and eventually transforms into a stone—a kidney stone.

Kidney stones. Click on the image for a larger, clearer version.

There are typically a few types of kidney stones, with calcium stones being the most prevalent.

NOW, HOW DO THESE STONES FORM IN THE URINARY TRACT?

There are several factors contributing to their formation.

  • Structural abnormalities along the kidney tract.
  • A malfunction in the body, leading to a higher risk of stone formation in the urine.
  • Lifestyle choices.
  • It’s essential to consider the presence of other concurrent medical conditions. For instance, diabetes and cholesterol can contribute to stone formation as well.
KIDNEY STONES ARE INCREASINGLY MORE COMMONLY DIAGNOSED AMONG YOUNGER PEOPLE?

I can’t provide an exact prevalence, but it’s evident that kidney stones are becoming more frequently diagnosed in young people, especially young women.

There are several reasons contributing to this trend.

  • Improved medical care leads to more regular check-ups that detect the presence of kidney stones.
  • Modern lifestyle, characterized by the consumption of fast and convenient foods. Such processed foods tend to be high in salt content, a known risk factor for stone formation. Moreover, sugary beverages, processed drinks, and excessive sugar consumption also contribute to the risk of stone formation.

In the case of young women, several additional factors may play a role.

  • Many of them desire to maintain a lower body weight, which leads them to adopt special diets that may lack proper balance. This imbalanced diet can contribute to stone formation.
  • Their busy lifestyles and work commitments may result in reduced water intake and holding in of urine for extended period of time (finding a restroom can become inconvenient). This inadequate hydration can also lead to stone formation.
OTHER INTERESTING POSSIBLE RISK FACTORS OF KIDNEY STONES AMONG YOUNGER PEOPLE
  • Climate change. Rising temperatures lead to increased dehydration. While outdoor activities and games are encouraged, inadequate water intake during these activities can contribute to stone formation.
  • Antibiotic misuse. The direct role of antibiotics in the formation of kidney stones remain uncertain. They may affect the formation of kidney stones indirectly, probably by causing issues related to nutritional absorption in the gut.
SYMPTOMS OF KIDNEY STONES

Kidney stones can present in various scenarios. For instance, some patients may exhibit symptoms like pain, bleeding, or fever when the stone obstructs the urinary tract, causing an infection.

Alternatively, kidney stones may be detected early in some fortunate cases, while these stones are still small, and hence there are no significant issues.

So, the manifestations of symptoms of kidney stones can vary.

POTENTIAL CONSEQUENCES AND COMPLICATIONS OF UNTREATED KIDNEY STONES

The stone might not cause any significant issues to the person’s quality of life if it is quite small.

However, the kidney stone may block the ureter—the passage in which urine is expelled from the body—creating a ‘traffic jam’ that leads to kidney swelling.

If left untreated, this blockage can lead to pain, infections and even kidney failure.

KIDNEY STONES MAY COME BACK OR RECUR IF ONE’S DIET IS NOT PROPERLY MANAGED

While water intake is often emphasized in relation to kidney stones, it is essential to consider other factors as well, such as salt and sugar intake.

Without proper diet management, there is a high chance of recurrence of 50% in 5 years, with some patients experiencing kidney stone formation again only 5 years after their initial operation.

This is also true for children. There is always a risk of kidney stone recurrence, especially if their diet is not properly managed.

Additionally, if a child has any structural or functional body issues that have not been adequately addressed by the doctor, it can also contribute to recurrent kidney stones.

HENCE, SPECIAL ATTENTION IS NEEDED FOR CHILDREN THAT HAVE EXPERIENCED KIDNEY STONES

They should undergo thorough medical assessments to rule out any body structural defects or functional problems that could lead to stone formation.

Proper management and monitoring are also essential.

TIPS TO REDUCE THE RISK OF KIDNEY STONE FORMATION
  • Adopt a healthy lifestyle. This is crucial. It involves maintaining a balanced diet, controlling one’s body weight, engaging in regular exercise, and managing blood sugar and cholesterol levels.
  • Drink an adequate amount of water daily as it helps in both hydrating the body and flushing out stones.
  • Avoid or limit foods that are high in sugars and salt.