Triumph Over Migraines with Accurate Diagnosis and Proper Medication

Dr. TSOI Tak Hong

Co-Director, Neurology Centre

Honorary Consultant in Neurology

Specialist in Neurology

As a type of primary headache, a migraine is not caused by any underlying disease. While it is considered a brain disorder, in most cases no abnormality is detected in brain scan.

For migraine, painkillers are no more than a short-term fix; in fact they can make migraine worse when overused. And to truly improve one’s quality of life, it is important to not only mitigate but also prevent headaches by early diagnosis and proper treatment.

Effective Treatment Hinges on Accurate Diagnosis and Proper Prescriptions

According to the WHO’s Global Burden of Disease Study in 2016, migraine ranked as the second major cause of disability worldwide. While being non-fatal, migraine can lead to reduced productivity (due to sick leaves) and serious impact on the quality of life. And to make it less frequent and less severe, accurate diagnosis and proper prescriptions are essential. 

Headache May Get Worse with Painkiller Overuse

The key to mitigating headache is a relaxed lifestyle. Adequate sleep and less Consumption headache-inducing food can help as well. As far as painkillers are concerned, paracetamol is effective enough for mild cases. NASIDs such as COX-2 are more potent painkillers with less impact on the stomach.

As migraine can last for 1 to 3 days, sometime triptans or ergots are prescribed for better pain control when paracetamol or NASIDs fails or if one can feel the onset of severe acute migraine.

The more frequent the headaches, the more painkillers one may use for short-term relief. It is considered to be overused if over a period of 3 months or longer, 4 pills of paracetamol or 1 pill of ergot/triptan are taken daily for at least 3 days a week. Adverse outcomes include analgesic overuse headache, or even chronic migraine, which is characterised by at least 15 episodes of headache per month. It can severely affect one’s work and quality of life.   

Preventive Medications: Effective at Mitigating Headache and Improving Quality of Life

Instead of relying on painkillers, patients with migraine are often advised to use preventive medications well before the condition becomes chronic. Effective at reducing the frequency and severity of migraine, preventive medications are usually prescribed if migraine occurs at least 4 days a month, or because of the headaches one has to take at least 1 day of sick leave each month.

Common preventive medications include beta-blockers, antidepressants and antiepileptic drugs. Recently new drugs have also been developed specifically for treating acute migraine, acting on calcitonin gene-related peptide (CGRP) to achieve quick relief to patients.

Clinical trials show that preventive medications can reduce the episode and severity of headache to an acceptable level in over 80% of patients. With headaches becoming less frequent, i.e. from chronic to sporadic, most patients can return to work and resume a normal life within 1 or 2 years. Preventive medications can be stopped as soon as the headache is under control, and patients can again use painkillers as per prescription for mild cases.