Quick answer. A migraine is a throbbing headache, often on one side of the head, typically with nausea and sensitivity to light and sound, and sometimes a visual “aura”. Acute attacks are treated with simple analgesics or, for more severe attacks, migraine-specific triptans – but using acute painkillers too often (broadly more than about 10-15 days a month over several months) can cause medication-overuse headache. If attacks are frequent, doctors add a daily preventive such as a beta-blocker, certain antidepressants/anticonvulsants, or a newer CGRP-targeted treatment, alongside identifying triggers. Most migraine can be managed by a GP; see a neurologist if attacks are frequent, severe, atypical or not responding – and seek urgent care for red-flag headaches such as a sudden “thunderclap”, worst-ever headache, headache with fever and a stiff neck, or any new weakness, numbness or speech problem.
Migraine is one of the most common neurological conditions, and in Singapore it can usually be controlled well with the right mix of acute relief, prevention and trigger management. This guide explains how a migraine differs from an ordinary headache, the treatments available here (including newer CGRP-targeted options), how to avoid medication-overuse headache, the danger signs that need urgent assessment, and when to step up from your GP to a neurologist. It is general information, not a substitute for a personal medical assessment.
At a glance
| Approach | What it involves | Notes |
|---|---|---|
| Acute relief (mild attacks) | Paracetamol or NSAIDs (e.g. ibuprofen, naproxen), taken early | First-line for milder attacks; limit frequent use to avoid medication-overuse headache |
| Acute relief (moderate-severe) | Migraine-specific triptans (e.g. sumatriptan), plus anti-nausea medicine | Used when simple analgesics are not enough; take at attack onset |
| First-line prevention | Beta-blocker (propranolol), tricyclic (amitriptyline/nortriptyline), anticonvulsant (topiramate, valproate), or flunarizine | Daily medication for frequent/disabling migraine; benefit builds over weeks |
| CGRP-targeted prevention | CGRP monoclonal antibodies – erenumab, fremanezumab, galcanezumab, eptinezumab (injection/infusion) | HSA-approved; available in tertiary hospitals, usually after first-line preventives |
| Lifestyle & triggers | Regular sleep and meals, hydration, stress management, exercise, trigger avoidance, headache diary | Supports medication and reduces attack frequency; useful for everyone |
| Urgent assessment | A&E for thunderclap/worst-ever headache, fever + stiff neck, new neurological signs, head injury, or new headache over 50 | Red flags may signal a serious secondary cause – do not delay |
What a migraine is – and how it differs from an ordinary headache
A migraine is a distinct type of headache, not just a “bad” tension headache. According to HealthHub, migraine pain is typically throbbing, often begins above the eyes and affects one side of the head, and tends to worsen with physical activity. It is commonly accompanied by nausea or vomiting and sensitivity to light, sound and smells. A migraine can last from a few hours to a few days and may move through phases – a prodrome (warning signs such as mood changes, food cravings or neck stiffness), an aura, the headache itself, and a postdrome “hangover”.
About one in five people experiences an aura before or during the attack. A typical visual aura is a flickering, jagged or zigzag line at the edge of vision, sometimes with numbness or tingling of the lips, face or fingers, usually lasting under an hour.
By contrast, a tension headache causes a more constant pressure or tightness around the head – a band-like, non-throbbing pain – usually without nausea or strong light/sound sensitivity, and is often linked to stress or fatigue. A cluster headache causes severe, sudden one-sided pain (typically around the eye) in bouts. Recognising these differences helps your doctor choose the right treatment.
Common migraine triggers
Migraine attacks are often set off by identifiable triggers, though these vary from person to person. HealthHub lists common ones including:
- Skipped or delayed meals and dehydration
- Disrupted sleep – too little or too much
- Stress (and sometimes the let-down after stress)
- Certain foods and drinks – alcohol (especially red wine), caffeine, aged cheese, preserved or cured meats, and MSG-containing foods
- Hormonal changes, such as around menstruation
- Environmental factors – glaring lights, strong smells and weather changes
Keeping a simple headache diary (noting dates, severity, possible triggers and medication used) is one of the most useful things you can do. It helps you and your doctor spot patterns, avoid triggers and judge whether treatment is working.
Acute (abortive) relief – and avoiding medication-overuse headache
Acute treatment is taken during an attack to stop or ease it, and works best when taken early. Singapore clinicians generally use a stratified approach based on how severe the attack is. For milder attacks, simple analgesics such as paracetamol (acetaminophen) or NSAIDs (e.g. ibuprofen, naproxen) are first-line. For moderate-to-severe attacks, migraine-specific triptans (such as sumatriptan) are used. Anti-nausea medicines may be added.
An important caution: using acute painkillers too frequently can paradoxically cause more headaches. Medication-overuse headache (MOH) can develop in someone with a pre-existing headache disorder who regularly overuses acute medication for more than three months. As a rough guide, regular use on more than about 10-15 days a month raises this risk. If you find yourself reaching for painkillers most days, see a doctor rather than increasing the dose – treating MOH usually means stopping the overused medication, with medical support, and starting a preventive.
This guide does not give individualised dosing; the right medication and dose should be decided with your doctor or pharmacist.
Preventive treatment for frequent migraine (including CGRP options)
If migraines are frequent, disabling, or acute treatment isn’t enough, a doctor may start a daily preventive to reduce how often and how severe attacks are. Preventives are taken regularly, and it can take some weeks to see the benefit. Commonly used first-line preventives in Singapore include:
- Beta-blockers – e.g. propranolol
- Tricyclic antidepressants – e.g. amitriptyline or nortriptyline (used here for headache prevention, not depression)
- Anticonvulsants – e.g. topiramate or valproate
- Flunarizine (a calcium-channel blocker)
For people who don’t respond to or can’t tolerate these, newer CGRP-targeted therapies are available. The Health Sciences Authority (HSA) has approved CGRP monoclonal antibodies – such as erenumab, fremanezumab, galcanezumab and eptinezumab – for migraine prevention; these are typically given by injection or infusion and are available in tertiary hospitals. Rimegepant, an oral CGRP “gepant”, has also been moving through HSA approval for acute and preventive use. Availability and suitability differ by case, so discuss options with your doctor.
Lifestyle management
Medication works best alongside steady daily habits that lower your overall migraine burden:
- Keep a regular sleep schedule – consistent bed and wake times help most.
- Don’t skip meals, and stay well hydrated through Singapore’s heat.
- Manage stress with realistic workloads, breaks, exercise and relaxation techniques.
- Exercise regularly – moderate, consistent activity can reduce attack frequency.
- Limit known triggers identified from your diary (e.g. specific foods, alcohol, excess caffeine).
These changes won’t replace treatment for frequent migraine, but they make medication more effective and can reduce how often you need acute relief.
Red-flag headaches, and when to see a GP vs a neurologist
Seek urgent medical care (A&E or call 995) if a headache comes with any of these warning features, which can signal a serious cause such as bleeding in the brain, infection or stroke:
- A sudden, severe “thunderclap” headache that peaks within seconds to a minute, or your worst-ever headache
- Headache with fever and a stiff neck
- New weakness or numbness in the face, arm or leg, or speech or swallowing difficulty
- Headache after a head injury
- A new headache in someone over 50, or in anyone who is immunocompromised
For non-emergency headaches, start with your GP (family doctor) – most migraine is managed well in primary care. Ask for referral to a neurologist if migraines are frequent or severe, don’t respond to first-line acute or preventive treatment, have atypical features or possible red flags, or if you’ve developed medication-overuse headache and need supervised withdrawal. In Singapore, the National Neuroscience Institute (NNI) operates at Tan Tock Seng Hospital and Singapore General Hospital.
Related guides
- Best Neurology Clinics in Singapore — our editorial shortlist
- neurology clinics directory
- Stroke warning signs (FAST)
- Dementia & memory loss
- Vertigo & dizziness
Sources
- HealthHub (MOH) – Headache and Migraine
- SingHealth – Effective Management of Migraine in Primary Care
- National Neuroscience Institute (NNI) – When to see a doctor for headache
- MIMS Singapore – CGRP-targeted therapies in migraine management
- Mount Elizabeth Hospitals – Migraine: Symptoms & Causes
Related conditions & guides
Related conditions and guides you may find useful:
- Bell’s Palsy in Singapore
- Epilepsy & Seizures in Singapore
- Parkinson’s Disease in Singapore
- Peripheral Neuropathy in Singapore
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