Headaches & Facial Pain
Migraines: Causes, Symptoms & Treatment at a Pain Clinic
What Are Migraines?
Migraines are far more than just bad headaches. They are a complex neurological condition that can significantly impact your daily life, affecting your ability to work, socialise, and carry out everyday tasks. Whether you experience occasional attacks or frequent, debilitating episodes, recognising the symptoms and seeking timely care is essential. If you often struggle with migraines, support from a pain clinic experienced in managing them can make a real difference.
What Are the Symptoms of Migraines?
Migraines are more than just headaches, they are a neurological disorder characterised by recurring episodes of intense, throbbing headaches, often on one side of the head. The pain usually lasts anywhere from 4 to 72 hours, and is often accompanied by additional symptoms such as:
- Throbbing or pulsating headache
- Increased sensitivity to light, sound, and odors
- Nausea
- Vomiting
- Aura (visual disturbances, numbness, or tingling in the face or limbs, usually 10-60 minutes before the headache starts)
If you experience these symptoms frequently, it may indicate that you have migraines rather than a regular tension headache. Our migraine specialist in Singapore can help determine the difference.
What Can Trigger Migraine Episodes?
Migraines are often triggered by specific factors, known as migraine triggers. Common triggers include:
- Stress & Anxiety: Emotional stress is a major trigger for many migraine sufferers.
- Menstruation: Many women experience migraines around their period due to hormonal changes.
- Skipping Meals: Irregular eating habits can trigger an episode.
- Weather Changes: Fluctuations in weather, like barometric pressure changes, can bring on migraines.
- Inadequate Sleep: Poor sleep patterns or lack of rest can increase the likelihood of a migraine attack.
Identifying and avoiding your personal triggers can help reduce the frequency of your migraines.
Who Is Likely to Get Migraines?
Migraines can affect both children and adults, though women are more likely to experience migraines than men. Several factors contribute to who may develop migraines:
- Gender: Women are more prone to migraines, particularly due to hormonal changes during menstruation, pregnancy, or menopause.
- Genetics: If you have a family history of migraines, you're more likely to experience them yourself.
- Age: Migraines often begin in adolescence or early adulthood, and can become more frequent or intense over time.
How Does My Doctor Diagnose My Headache?
What is Frozen Shoulder?
The shoulder joint is where the shoulder blade (the bone in your upper back) and the upper arm bone meet. It's surrounded by a protective covering called a joint capsule, and inside it is a slippery fluid called synovial fluid. This fluid helps the shoulder move smoothly and without pain. The exact cause of frozen shoulder isn't fully understood, but it’s believed to involve both inflammation and the thickening of the tissue around the shoulder joint. This makes the shoulder stiff and painful, limiting its movement. It often happens without any obvious reason, but it can sometimes develop after an injury or when the shoulder is kept still for a long time (like when wearing a sling after a fracture).
What are the risk factors for frozen shoulder?
The following factors can increase the risk of developing frozen shoulder:
- Keeping the shoulder still for a long time (like wearing a sling)
- Rotator cuff problems
- Being less mobile because of an illness (like after a stroke or surgery)
- Health conditions like diabetes or thyroid problems
- Parkinson's disease
- Gender (women are more likely to get it than men)
- Age (it’s more common in people over 40)
What are the symptoms of frozen shoulder?
People with frozen shoulder often notice pain and stiffness in the shoulder that develops slowly over time. For many, the pain gets worse at night, making it hard to sleep on the affected side. Along with the pain, they may find it difficult to move the shoulder in different directions, which can interfere with daily tasks. The condition usually gets worse in stages, but not everyone will go through the stages in the same way. Stages of Frozen Shoulder:
- Freezing Stage (about 3 months) – This stage is mainly marked by pain, and the shoulder becomes harder to move.
- Frozen Stage (about 3 to 9 months) – The pain starts to go down, but the shoulder stays very stiff and still difficult to move.
- Thawing Stage – The shoulder gradually starts moving more easily, and everyday tasks get easier. Pain and stiffness usually improve, but there's a chance the problem could come back.
How do doctors diagnose this condition?
Frozen shoulder (also called adhesive capsulitis) is diagnosed based on your symptoms and a physical exam by a doctor. Sometimes, if the diagnosis isn't clear, the doctor may order extra tests like an MRI or ultrasound. However, these scans aren't usually needed to confirm frozen shoulder.
What are you treatment options?
Frozen shoulder usually improves on its own, but the process can be slow and take up to 3 years. Even after it gets better, some people may still have lingering symptoms. Treatment can help speed up recovery, and there’s some evidence that people who get treatment may have better long-term movement in their shoulder. Fortunately, most people with frozen shoulder can get better with non-surgical treatments, which include:
- Exercise or physical therapy
- Shoulder joint hydrodilatation (a procedure to stretch the joint)
- Corticosteroid injections into the shoulder
- Manipulation under anesthesia (a procedure where the shoulder is gently moved while you're asleep) In rare cases, if these treatments don’t work, surgery might be considered.
What is Shoulder Hydrodilatation?
Hydrodilatation is a simple, minimally invasive treatment for frozen shoulder. It’s usually done in a clinic with a needle, although in more complex cases, it may be done in a special treatment room with X-ray guidance. The goal is to inject fluid into the shoulder joint to stretch the thickened joint capsule, help reduce inflammation and improve movement, and it can be done at any stage of the condition. This procedure is very effective. Most people see a big improvement in their shoulder's range of motion after just one injection. It not only helps with movement but also relieves pain, which is important because pain can make it harder to stretch the joint and improve mobility. Recovery is usually quick, and most patients can return to normal activities the same day. It's also recommended to do stretching exercises to help with recovery. Hydrodilatation is generally safe when done by experienced specialists, but it’s important to talk to your doctor about the benefits, risks, and other options before deciding if it’s right for you.
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Diagnosing a migraine involves a thorough clinical history and physical examination. Your doctor will ask about the following:
- The pattern and duration of your headaches.
- The presence of any aura or other neurological symptoms.
- The frequency and intensity of your attacks.
Imaging (such as MRI or CT scans) is typically not required for a standard migraine diagnosis, but it may be recommended if you have:
- Atypical symptoms (e.g., unusual patterns or sudden changes in headache type).
- Neurological symptoms (e.g., numbness, weakness).
- Systemic symptoms (e.g., unexplained weight loss or fever).
These tests help rule out other serious conditions.
What Are the Options for Migraine Treatment?
Treatment for migraines can be divided into abortive and preventive therapies.
1: Abortive Medications (For Immediate Relief)
When a migraine strikes, abortive medications aim to relieve the pain quickly. These medications should be used at the onset of symptoms:
- Over-the-counter pain medications like Paracetamol and Ibuprofen may help with mild migraines.
- For more severe cases, prescription medications such as Triptans (Sumatriptan, Zolmitriptan) or Cafergot may be needed to relieve the pain. These medications work by narrowing the blood vessels in the brain.
- Anti-nausea medications may also be prescribed if nausea and vomiting are present.
2: Preventive Medications (To Reduce Frequency and Severity)
If your migraines occur more than once or twice a week, your doctor may recommend preventive treatments. These medications aim to reduce the frequency and intensity of your migraine attacks over time:
- Beta-blockers (commonly used for high blood pressure)
- Calcium channel blockers and ACE inhibitors
- Anticonvulsants (commonly used for seizure disorders)
- Antidepressants (also effective for migraine prevention)
- Botulinum toxin (BTX) injections (FDA-approved for chronic migraines)
- Anti-CGRP treatments (a newer and effective class of migraine medication)
What Should I Do If I Have a Migraine That Doesn’t Go Away?
If your migraine persists for more than 72 hours, it may be classified as Status Migrainosus, a severe and prolonged migraine that does not respond to standard treatments. This condition is debilitating and can significantly impact your quality of life.
Treatment for Status Migrainosus often involves more aggressive measures, such as:
- IV fluids to combat dehydration
- IV anti-nausea medications
- IV medications to reduce the severity of the headache
- Nerve blocks to target pain receptors
- Botulinum toxin injections (as a last resort)
If you experience a migraine lasting longer than 72 hours, it’s crucial to seek medical help promptly.
How Does Pregnancy Affect Migraines?
Pregnancy often leads to significant hormonal changes, which can affect the frequency and intensity of migraines. Many women report improvement in their migraines during pregnancy, especially in the second and third trimesters. However, migraines can still return after childbirth, particularly during the post-partum period.
It’s important to consult your doctor if you’re pregnant or planning to become pregnant because some medications used to treat migraines can be harmful to the developing fetus. Additionally, medications can enter breast milk, so discussing treatment options for nursing mothers is essential.
Get Professional Help for Your Migraines
Migraines can be debilitating, but with the right care, they’re manageable. Dr Christopher Liu, a migraine and headache specialist in Singapore, offers expert diagnosis and tailored treatment options.
As an experienced migraine doctor based at our pain management clinic in Singapore, he will help determine whether your condition is a headache or a migraine, and work with you to reduce symptoms and improve your day-to-day life.
FAQ
What is the best treatment for migraines?
It depends on how often your migraines occur and how severe they are. For mild cases, over-the-counter pain relief may help. If your migraines are frequent or severe, our migraine specialist in Singapore may recommend preventive options such as BTX or anti-CGRP treatments.
Should I go to a clinic if I keep getting migraines?
Yes. If migraines are affecting your daily life, visiting a clinic like Alleviate Pain Clinic can help identify your triggers and get you on the right treatment plan.
Can migraines be cured?
There is no permanent cure, but with the right treatment plan, you can significantly reduce how often they happen and how severe they are. Our headache and migraine specialist in Singapore will work with you on a personalised approach combining medication, lifestyle changes, and trigger management.
How do I know if it is a migraine or just a headache?
A regular headache usually feels like mild pressure across the head. Migraines tend to be more intense, with throbbing pain on one side, nausea, and sensitivity to light or sound. If you are unsure, our doctor can help with an accurate diagnosis.
What happens during my first migraine consultation?
During your first visit to Alleviate Pain Clinic, our specialist will review your medical history, discuss your symptoms and triggers, and carry out a physical examination. Based on the findings, we may recommend further tests or start you on a treatment plan tailored to your condition.
