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Not a bad headache. A neurological condition with its own phases, its own triggers and its own treatment — which is why ordinary painkillers so often fail, and why the right prevention can change how much of your life it takes up.
No — and anyone promising one should be treated with suspicion. Migraine is a long-term neurological condition, not an infection to be cleared.
What can be done is considerable, and it is worth being precise about it. Attacks can be stopped faster and more reliably. Their frequency can be reduced substantially, sometimes to a fraction of what it was. And where medication has not worked, treatment can be directed at the nerves themselves.
The realistic goal is not a life without migraine. It is migraine that no longer decides what you can plan.
Migraine is a recurring, severe headache, usually on one side of the head, with a throbbing or pulsing quality that worsens with movement. It is often accompanied by nausea and by sensitivity to light and sound — which is why most people want a dark, quiet room.
The pain can last from four hours to three days. In some people it affects both sides, or spreads into the face or neck. Afterwards, many feel drained for several days.
Some people experience the sensory disturbances of migraine with no headache at all — that is silent migraine. Where the disturbance is to balance rather than vision, producing vertigo instead of a headache, it is vestibular migraine.
Migraine is not simply pain that starts and stops. It moves through phases, and recognising the early ones is what makes it possible to treat an attack before it is fully established — when treatment works best. Not everyone has all four.
Hours to days before
Subtle warning changes: mood shifts, food cravings, neck stiffness, yawning, thirst, or needing to pass urine more often. Easy to dismiss until you learn to spot them.
5 to 60 minutes before
Reversible sensory disturbance affecting about a third of people: zigzag lines, flashing dots, blind spots, tingling in a hand or face, or difficulty finding words. It resolves as the headache begins.
4 to 72 hours
The attack itself. Throbbing pain, usually one-sided, worse on movement, with nausea and sensitivity to light, sound and sometimes smell.
Up to a week after
The "migraine hangover". Exhaustion, difficulty concentrating, a washed-out feeling. Frequently mistaken for the migraine continuing when it is the recovery.
Alongside the headache, people commonly report:
Triggers vary enormously between people, and the same trigger does not produce an attack every time — which is what makes them so hard to identify without a record. Common ones include sleep disruption, skipped meals, dehydration, particular foods, hormonal changes, bright or flickering light, strong smells, weather changes and stress, including the release after stress rather than the stress itself.
Keep a diary for two to four weeks before your appointment. Record when each attack started, how long it lasted, what you had eaten, how you had slept, where you were in your cycle if relevant, and what you took. Patterns emerge that are invisible from memory alone, and it is usually the most useful thing you can bring.
Diagnosis is made on the history and examination — the pattern of attacks, their character, what accompanies them, and a neurological examination. There is no test that confirms migraine.
Investigation is used where the presentation is unusual, has changed, or the examination raises a question — to exclude other causes rather than to confirm migraine:
Migraine treatment works on three fronts, and most people need more than one. All three are available at this clinic in Singapore.
Treatment taken at the start of an attack, aimed at cutting it short rather than waiting it out. Timing matters more than dose — taken early it often works, taken late it often does not, which is why recognising the prodrome is worth learning.
A caution worth knowing: acute medication taken more than two or three days a week can begin causing headaches of its own. If your painkiller use has crept up, say so — it is common, and it is reversible.
Taken regularly rather than at the time of an attack, to reduce how often attacks occur and how severe they are. This is where most of the gain is for anyone having frequent migraines.
Options include established preventive medication and newer CGRP inhibitors, which were developed specifically for migraine rather than borrowed from other conditions. Which suits depends on your pattern, your other medical history and what else you take.
Where medication has not controlled the attacks or is not tolerated, treatment can be directed at the nerves carrying the pain. Dr Tung's practice includes:
These are the options that most often separate specialist management from a repeat prescription, and they are the reason migraine that has not responded to tablets is still worth bringing in.
A sudden, severe headache unlike any you have had before needs same-day assessment at an emergency department. So does a headache with fever and a stiff neck, or with new weakness, numbness, slurred speech, confusion or visual loss.
An aura that lasts longer than an hour, affects only one side of the body, or appears for the first time after the age of 50 should also be assessed promptly rather than assumed to be migraine.
No. It is a neurological condition with distinct phases, its own triggers and its own treatments. The headache is one phase of four, and some people have migraine without any headache at all.
Usually timing. Acute treatment works best taken early, before the attack is fully established. Once it is, the same dose often achieves little. Learning to recognise your prodrome is what makes the difference.
Yes, and for anyone with frequent attacks that is where most of the benefit lies. Preventive medication is taken regularly to reduce the number and severity of attacks, rather than to stop one in progress.
A class of preventive treatment developed specifically for migraine, targeting a protein involved in the attack. They are an option where older preventives have not worked or were not tolerated. Suitability is assessed individually.
Usually not. Migraine is diagnosed from the history and examination. Imaging is used to answer a specific question — not to confirm migraine, which it cannot do.
No. You can book directly. Bring your headache diary if you have kept one, and any scans and reports.
Headaches (all types) · Silent migraine · Vestibular migraine · Cluster headache · Tension headache · Cervicogenic headache · Dizziness and vertigo · Neuromodulation
Bring your diary if you have one. You will leave with a diagnosis and a plan for reducing how often this happens.
