For some, it hits once in a blue moon. Others, as frequently as every few days. Yes, we’re talking about the migraine; a neurological disorder that, according to the World Health Organisation, affects approximately 40% of the world’s population. Characterised as a recurrent and acute condition, its severity typically varies according to the individual—though it is safe to say that in most cases, a migraine is disruptive enough to cause disturbances to daily life.
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“A migraine is far more than just a bad headache. It is a complex neurological disorder involving changes within the brain, nervous system, blood vessels, and sensory processing pathways,” elucidates Dr Jon Marshall, the founding director of Singapore Headache and Migraine Clinic. “While many people associate migraine purely with pain, migraines can also involve symptoms such as nausea, dizziness, sensitivity to light and sound, visual disturbances, neck pain, fatigue, and difficulty concentrating.”
At the crux of it, this is precisely what makes migraines quite so complicated; its effects present differently according to the patient, and also encompasses a broad spectrum that makes pinning it down a beast on its own. Dr Martin John, director and osteopath of Orchard Health Clinic, is quick to point out that “symptoms don’t follow the traditional rulebook.”
“In fact, some migraines are one-sided and throbbing. Others affect both sides of the head, target the neck or face, or mainly cause dizziness and visual symptoms,” Dr John reports. “Some barely hurt at all. Often, patients use ‘migraine’ simply to indicate severe pain intensity rather than the actual condition itself. But migraine isn’t defined purely by pain intensity. It’s better understood as the nervous system struggling to process sensory information, stress, and pain signals appropriately.”
@lifewithmigraine if one more person tells me to “just” … 🫠 #migraine #chronicmigraine #migrainelife #fyp ♬ Fortunate Son – Creedence Clearwater Revival
This brings forth the question: how are we to better understand a condition that is contingent on an individual’s health and body? We sit down with Dr Marshall and Dr John to unpack this, from grasping the most common triggers to knowing when is the best time to seek medical attention.
Who is likely to be afflicted with a migraine?
According to Dr Marshall and Dr John, migraines can affect people of all ages. However, they are more common in women and can begin as early as adolescence.
“It shows up especially between puberty and menopause, when hormonal fluctuations appear to play a major role,” states Dr John. “There’s also often a strong family history. When asking migraine patients about relatives, someone usually had bad headaches or similar symptoms, even if they were never formally diagnosed. People affected by migraines also tend to be sensitive to stress, poor sleep, sensory overload, or changes in routine. Many function extremely well most of the time, until the nervous system becomes overwhelmed and tips into a migraine episode.” He goes on to add: “Interestingly, migraines can present differently across age groups. Children may experience stomach pain, nausea, or dizziness rather than headache, while older adults sometimes develop more visual or balance-related symptoms with less pain.”
What are the most common triggers out there?
- Stress
- Poor sleep
- Hormonal changes
- Sensory overload
- Dietary factors
- Disruptions to normal routine
- Dehydration
- Excessive screen time
- Heat and humidity
How can you tell between a bad headache and a migraine?
“One of the key differences between a standard headache and a migraine is the associated neurological symptoms. A typical tension type headache is often described as a dull pressure or tightness around the head. Migraines are usually more severe and may present with throbbing pain, nausea, visual symptoms, light sensitivity, sound sensitivity, or worsening with movement and exercise,” explains Dr Marshall. “Some people also experience what is known as an ‘aura,’ which may include flashing lights, blind spots, numbness, or speech disturbances before the migraine begins.”
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On that note, Dr John also raises another difference. “Another important distinction is how disabling migraines can become. While people with normal headaches may still be able to carry on with the help of over-the-counter medication, many people with migraines struggle to function normally during an attack and may need to stop work, lie in a dark room, or avoid noise and movement until the episode settles.”
Are migraines a symptom of another underlying condition?
Not exactly. “Most migraines are considered a primary neurological condition, meaning the migraine itself is the disorder rather than a symptom of another disease,” Dr John clarifies.
Dr Marshall agrees, though with a caveat: “Headaches and migraine-like symptoms can sometimes be secondary to other underlying medical issues—this is why a proper assessment is important. Certain headaches may relate to cervical dysfunction, medication overuse, hormonal changes, vascular conditions, concussion, infections, or other neurological disorders. Red flags such as sudden severe onset, loss of consciousness, neurological weakness, changes in speech, fever, or headaches associated with trauma should always be medically assessed urgently.”
What are the best possible treatment options for a migraine?
“Treatments for migraines generally fall into two broad categories: treatments used during an attack itself, and treatments aimed at prevention. During an acute migraine, people may use over-the-counter medication, anti-nausea medication, or migraine-specific drugs prescribed by their doctor to help reduce symptoms,” says Dr John. “Preventive treatment is often broader and may involve improving sleep, stress management, trigger reduction, and lifestyle modification.
Many people with migraines also experience increased sensitivity around the head and neck region, along with stiffness or pain in those areas. In these cases, hands-on treatment, movement therapy, breathing work, and exercise-based rehabilitation may help reduce some of those mechanical and sensory stressors.”
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Whereas Dr Marshall believes in a more “multidisciplinary and individualised” approach.
“Medication can play an important role, particularly for acute symptom relief and prevention in more severe cases. However, management should not stop there. At our clinic we take a more integrated manual medicine approach, addressing factors such as cervical spine dysfunction, muscular tension, breathing patterns, posture, ergonomics, movement quality, stress regulation, hydration, sleep, and exercise capacity,” he notes. “Lifestyle modification is often a critical component in reducing migraine frequency and improving long term outcomes.”
