You’ve got a pounding headache and you don’t feel like getting out of bed. You reach out for your phone to call in sick, but think, “Eh, can get MC or not ah?”
Before you tell your boss that you’ll be on medical leave, it’s best to see a doctor first because according Dr Jonathan Ong, President of the Headache Society of Singapore, “Not all patients will be categorically granted medical leave during a migraine attack if they consult a doctor.”
He says, “This depends on the patient’s condition and the assessment of the attending physician. If a patient is having a severe migraine attack and has significant symptoms rendering him or her unfit for work, the doctor may certainly grant a medical certificate for the patient to fully recuperate before returning to the workplace.”
So what can you do if you do have a migraine at home or at work?
He suggests finding a calm environment and retreating from your usual activities at the first sign of a migraine attack.
He also recommends turning off the lights because “during a migraine attack, there is often increased sensitivity to light and sound.” He adds that you should relax in a dark, quiet room and sleep if you can.
You can also try applying hot or cold compresses to your head or neck—ice packs can dull the sensation of pain while hot packs can relax tense muscles.
Another treatment is to take analgesics as early as possible when you’re experiencing mild pain.
“Many tend to adopt a ‘wait-and-see’ approach and consume analgesics later in the course of their attack when the pain intensity is more severe. This is a misconception as delayed administration of acute medication leads to a more unsatisfactory effect. In addition, many experience nausea or vomiting. Thus medication taken later in the course of an attack may not be absorbed by the gut,” says Dr Ong.
Apart from taking medication—whether pain-relieving or preventive ones—he suggests making changes to one’s lifestyle, avoiding triggers and leading a healthy lifestyle to prevent migraine attacks.
“The treatment strategy depends on the frequency and severity of headaches, the degree of disability caused by the headaches, and other concomitant medical conditions.”
One way to find out or identify your trigger is to keep a detailed headache diary.
“Trigger factors can influence an attack up to 48 hours before a headache comes on. A diary can help patients to look at this period before each attack, and a noticeable pattern may emerge linking possible triggers with the occurrence of migraine headaches,” he says.
Also read: What Does Your Headache Really Mean?
Scroll through the gallery to find out the common triggers, according to Dr Ong.
But… a migraine is just a headache, right?
“A migraine is more than just a headache. It is a recurrent disorder with a wide array of symptoms. For many, the main feature is a painful headache,” says Dr Ong. He describes migraine attacks as “often very disabling and may result in one having to lie still for several hours”. It usually lasts from four to 72 hours, although you might feel well in between attacks.
Another reason why it’s more than just a headache: there’s a possibility you might develop a migraine complication, which includes stroke—migraineurs have approximately twice the risk of having a stroke—and migrainous infarction, a rare complication that mostly affects younger women.
“This condition always occurs with an aura (a set of unusual phenomenon like flashes of light, visual disturbances, and tingling of the hands or face) that lasts for more than 1 hour in duration. Symptoms such as limb and/or facial weakness or numbness, slurring of speech or gait unsteadiness occur suddenly and is an emergency. The patient develops a stroke in the area of the brain from which the symptoms of the aura originated. This stroke is seen by a doctor on a brain scan such as a MRI scan. Women under 45 who smoke cigarettes and take contraceptive pills have an increased risk of developing a stroke with migraine, especially if they have migraine with aura,” says Dr Ong.
Migraines can also lead to other health issues including depression, anxiety, vertigo and sleep disorders.
When do you seek medical attention for migraine?
You should seek medical attention if the headache you are experiencing is different from previous migraines—and yes, you can experience other headaches even if you have been diagnosed with a migraine.
“Some headache features are considered ‘red flags’, in that the symptoms and signs are indicative of a serious underlying cause for the headache. Physicians often use the acronym ‘SNOOP4” to help recall headache ‘red flags’. It is reasonable to seek medical attention if a headache is different from the typical migraine and is associated with one of the following ‘red flag’ features,” says Dr Ong. He outlines the red flags below.
S: Systemic symptoms & signs
Consult a doctor if you have: headaches accompanied by fever, neck stiffness, vomiting or rashes; headaches associated with an underlying bleeding disorder, underlying cancer diagnosis or underlying immune-compromised state (HIV/AIDS), or headache after recent head trauma.
N: Neurologic symptoms & signs
If you have headaches that associated with neurological signs or symptoms such as seizures, trouble with vision, clumsiness, impairment in strength on one side, impairment in level of consciousness or persistent vomiting, seek medical attention.
O: Onset sudden
A sign that you need medical attention: if you experience headaches that are sudden and explosive, reaching maximum intensity within one minute.
O: Older person
Anyone who develops his or her first headache over the age of 50 years should seek medical attention. If, however, you are experiencing your typical migraine, but happen to be over the age of 50 years, medical attention is not necessary.
P: Previous headache history (new/first/worst/different/change)
Seek medical attention if you’re experiencing headaches that have changed from a prior headache type, the worst headache in of your life, your first severe headache, or headaches that are progressively more frequently, severe in intensity, or persistent despite medication. You should also seek medical attention if you are unable to cope with the pain, or if a new headache causes you to wake from sleep.
P: Precipitated by Valsalva
If you experience headaches that are made worse by bearing down, coughing, sneezing, exertion or sexual intercourse, consult a doctor.
P: Postural headaches (upright or lying flat)
Consult a doctor if you have headaches that are consistently worse in the morning or when lying flat. You should also seek advice if you have headaches that are consistently worse when sitting or standing up and relieved when lying flat.
P: Pregnancy or post-pregnant state
Have severe or new headaches developing during and post-pregnancy? Seek medical attention.