Headache and Migraine

Headache and migraine are among the most common causes of pain and discomfort. Learn what causes headaches and migraines and how to avoid triggers.

Article to be attributed to Anaesthesia, Ng Teng Fong General Hospital

There is no denying that while common, a throbbing headache can dampen any day. A headache, a pain that occurs in the temples, scalp or neck, is often harmless and can come under two broad categories: common headaches and migraines.

Common Headaches

Tension headaches are associated with stress or fatigue, arthritis, anxiety or depression. Women aged 20 to 40 are more prone to this type of headache than men.

Tension headaches can also be caused by poor posture, eyestrain, neck muscle or bone abnormalities, misaligned teeth or jaw bones and unusual noise or light. Symptoms include muscle tightness in the temple and forehead, a feeling of pressure around the head, and continuous but not throbbing pain.

Cluster headaches are named as such because they happen in “clusters”, up to four separate attacks a day. It is more common in men aged 25 to 45. This type of headache causes severe and intense pain that occurs suddenly on one side of the head and/or one eye. It may also cause tearing from the affected eye and a runny nose.

These headaches can last from under an hour to several hours and they often stop as quickly as they started. The risk of cluster headaches is linked to smoking, alcohol use and an increased level of histamine — an antibody that is released during an allergic response — in the blood. 

Benign exertional headaches are caused by physical exertion, such as running, bending and lifting, coughing or sneezing. Although the exact cause is unknown, one theory is that strenuous exercise dilates blood vessels inside the skull. This headache rarely lasts more than several minutes.


A migraine is also a type of headache, but it is chronic and more localised. It also occurs only in a particular area of the head. It usually comes on gradually, becomes progressively more painful and then gradually resolves.

The intensity, duration, symptoms and frequency often vary. What sets a migraine apart from a headache is that it often tends to progress through several stages:

The Prodromal Phase 

In the early stages, one or two days before a migraine, pre-migraine warning signs will appear. These may include: constipation, depression, food cravings, hyperactivity, irritability, neck stiffness, and in some cases, uncontrollable yawning.

The Aura Phase 

About one in five people experiences nervous system symptoms such as visual disturbances. A typical visual aura presents as a flickering, jagged or zigzag line that seems to appear at the corner of one's vision. Another sign is numbness and tingling of the lips, lower face and fingers of one hand. Some people may experience temporary paralysis on one side of the body.

Auras rarely last longer than an hour and in most cases, are followed by a headache. Some people do not experience the aura phase, but may have symptoms such as mood changes, fatigue, mental fuzziness, fluid retention, diarrhoea, increased urination, nausea and vomiting.

Other signs may include: nasal congestion, runny nose, tearing, and/or sinus pain or pressure.

The Attack Phase 

The migraine attack itself can last for a few hours to several days. The throbbing pain usually begins above the eyes and affects one side of the head. The pain may affect the entire head or move from one side to the other or spread to the lower face and the neck. It worsens during physical activity.

The Postdromal Phase

In the aftermath of a migraine episode, the sufferer may feel extremely euphoric.

Risk Factors and Triggers

Migraines can happen to anyone, but they tend to be more common in adult women than men. Some women may find that migraine attacks tend to coincide with hormonal changes and occur just before or shortly after onset of menstruation.

The risk of migraine is higher if there is a family history. Migraine is also linked to certain medical conditions such as depression and anxiety, cardiovascular disease, nasal or sinus inflammation, trauma to the brain from head or neck injury, and infections or haemorrhages in the brain and certain medications.

Environmental, emotional or food triggers can also bring on a migraine. Because severe and frequent migraine headaches can result in a poor quality of life, it is important to identify the factors that can lead to an attack.

Common triggers include:
Missing meals
Alcohol, especially red wine
Foods with monosodium glutamate (MSG)
Foods with caffeine (coffee, tea, colas)
Foods with nitrates and nitrites (found in preserved meats)
Foods with tyramine (found in aged cheese)
Menstruation, oral contraception use and menopause
Too little or too much sleep
Glaring lights, strong smells, weather changes or high altitude

Migraine is a complicated event and the symptoms may not always be the same for everyone. They usually occur in a recognisable pattern and can generally be diagnosed easily. Migraine is treatable and not life-threatening, but severe and frequent attacks can result in poor quality of life. If it becomes chronic, it can be difficult to eradicate.

Related Medical Conditions

Many people who suffer from migraines also suffer from a variety of other health issues, and some of these are found to commonly coexist with migraine. The causes are not always clear.

These include:
Depression and anxiety which coexist in many migraine sufferers
Cardiovascular disease which presents a slightly increased incidence of migraine
Nasal or sinus inflammation conditions which afflict many migraine sufferers
Certain medications, which can create a headache pattern that becomes migraine-like
Trauma or haemorrhages to the brain from head or neck injury, and infections

Pain Relief Tips

Because the cause of migraine is multifactorial, choosing the right strategy to manage a migraine depends on the frequency and severity of the headaches, the degree of disability they cause, and any other medical conditions.

In some instances, medication needs to be taken regularly to prevent/decrease the severity, length or frequency of attacks. These medicines can cause mild to severe side effects, and thus should only be taken according to directions and when prescribed by a doctor.

Non-drug treatments for migraine may be helpful, such as staying away from avoidable triggers, she adds. One way to manage chronic headaches is to keep a diary to help you and your doctor identify the triggers.

Take note of:
The day and time the pain started
What you ate and drank over the last 24 hours
The amount of sleep you had the previous night
What you were doing and where you were before the pain started
How long the headache lasted
What helped to ease it

See A Doctor If...

Often, migraine headaches go undiagnosed and untreated. It is thus advisable to visit a doctor for migraine just to rule out any sinister causes. And even if there has been a history of headaches, a doctor should be consulted if the pattern changes or the headaches suddenly feel different.

Consult a doctor immediately or go to the emergency department if your headache:
Is abrupt and severe
Occurs with a fever
Happens after a head injury, especially if it gets worse
Lasts for a few days or weeks and gets worse after coughing, exertion, straining or a sudden movement

By Bella Lim, in consultation with Dr Sabina Shibli, Senior Consultant, Anaesthesia and Pain Medicine, JurongHealth. The article titled "Oh, My Aching Head! " was first published in OneHealth, 2015, Issue 6.

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