Are frequent headaches causing you pain?​

For many people, headaches are an occasional annoyance that can be treated with non-prescription pain medication, but if they occur regularly they can affect a person’s work, school, family and/or social life.

Fortunately, most headaches are not a sign of a serious medical condition and can be managed.

Want to know more about headaches, migraines and when to seek medical attention? Dr Zhao Yi Jing, Consultant from the Department of Neurology at National Neuroscience Institute (NNI), a member of the SingHealth group, will be answering questions on this topic in this month’s ‘Ask the Specialist’ Q&A forum.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.

1.Posted by Y****
Hi Dr, 
I used to have migraine with headache and partial loss of vision. Now when my migraine comes, I don't have headache but I still suffer partial loss of vision. Is my condition serious?

Answered by Dr Zhao :
Dear Y****,
Thank you for your question. Migraine can be associated with visual auras that can cause specific vision disturbances before or during a migraine attack. However, it is unusual to have visual symptoms by itself without headache and I would advise to see a specialist for your condition.

2. Posted by D******
Hi Dr,
1.What is vascular migraine? Does it cause headache when one gets up from bed or turn one's head while lying down on the pillow?
2.What is the cure for vascular migraine? 

Answered by Dr Zhao :
Dear D******,
I have not heard of the term "vascular migraine", and it may not be an updated medical term. For migraine headache, it is commonly associated with a throbbing sensation during a headache attack, with symptoms of worsening of headache with physical activity or movements. Hope that helps!

3. Posted by P******
Dear Dr Zhao Yi Jing,
I am 62 years old and I have a problem with my headache, My right forehead sometimes throbs a little pain but only about 1 minute later it goes away, is this a potential sign of a mild stroke ?, I have a history of open heart surgery to take out the bullet in my heart in 2003, and I have an ablation surgery in 2019 for my afib problem, and my routine medicine is 10mg tombocor divide by 2 half at morning and half at evening, Concord 1,25mg in the morning and Crestor 5mg dayli, no other medicines.
Your response is very appreciated. Thank you.

Answered by Dr Zhao :
Dear P*****,
Thank you for your question. The current symptoms you are experiencing are non-specific and it is hard for me to comment whether it's a potential sign of mild stroke. There are many risk factors that are commonly associated with strokes, such as diabetes mellitus, hypertension, dyslipidaemia, smoking etc. I would advise that if the symptom persists, to seek a medical consult to have it properly evaluated.

4. Posted by H*****
Hi Dr,
1.Can hunger or low blood sugar cause headaches?
2.Can bad sleeping position for the head/neck cause headaches? 
3.Does going for regular massage for the head, neck and shoulder improve or lessen occurrences of headaches?

Answered by Dr Zhao :
Dear H****,
In my experience everyone has their own unique trigger for headache attacks, and this can be identified by the patient through pro-actively correlating their lifestyle habits with their headache attacks. This can be done by keeping a headache diary and recording down the headache attacks and lifestyle which can help to pick up possible triggers for headache attacks. There is currently no definite evidence to prove that head and neck massages can help to minimize headache occurrences. However, avoidance of triggers, staying hydrated, eating meals on time, exercising and avoiding stressors are all simple lifestyle measures that can help to mitigate headache attacks.

5. Posted by Z**
Dear Dr Zhao Yi Jing,
Good everything! I am honored to be able to ask you questions.
I often get headaches after I get stress and sleep less. Usually I feel dizzy first, and then start to feel pain near one temple, and the pain extends to one side of my nose. The headache lasts for about 12 hours, and only taking SODEN can stop the pain.
I’d like to know do I need to see a doctor and what tests do I need to do? What kind of medicine can I take to reduce headaches?

Answered by Dr Zhao :
Dear Z**,
Thank you for your question. Stress and sleep deprivation are common triggers for primary headaches such as tension-type headache or migraine. I usually suggest seeing a doctor if the patient feels that their primary headache condition is affecting their social life and work. The doctor will do a clinical evaluation based on the patient’s history and physical examination before deciding if further investigations are needed. There are many analgesia that can be taken to reduce headaches. Common ones such as paracetamol are easily available over the counter. However stronger and more headache-specific analgesia will require prescription from a doctor. 

6. Posted by A*****
Hi Dr,
What migraine medicines are available which do not cause vision impairment? I started getting floaters in my eyes after starting Proparanol.

Answered by Dr Zhao :
Dear A*****,
Propranolol is a migraine preventive that is given to migraine patients to decrease the frequency and intensity of headache attacks. There are currently many types of migraine preventive treatments available and I recommend you discuss the options with your primary care provider who can advise on other migraine preventives suitable for you based on your existing medical conditions and risk of medication side-effects. 

7. Posted by F*****
Hi Dr Zhao,
I have a friend who have frequent headache in normal days. It just happened quite frequent. My friend always get headache quite often. Hence, would like to ask what can be the cause of a headache that happens quite frequently on a daily basis/ weekly/monthly/every now and then? What could people who gets headache on regular days do to help mitigate with the frequent headache that they are getting? Thank you in advance!

Answered by Dr Zhao :
Dear F****,
I would advise that your friend consider seeing a doctor to be evaluated on the cause of the frequent headache. Frequent headaches can be either caused by an underlying pathology, or triggers that are unknown to the sufferer. Hopefully, by seeing a doctor, proper medical treatment can be given to mitigate the impact of the headache on his/her life.

8. Posted by L****
Dear Dr,
I have headache/migraines for about 1-3 times per week. The pain level can be 4 to 7(out of 10). This had been going for about a year plus. I understand headache can be due to reason such as stress. I wonder can it be due to neck strain/pain. I have tried to improve my posture, sleeping habits etc but not much improvement. Will going for chiropractic help?

Answered by Dr Zhao :
Dear L****,
Migraine can be commonly associated with neck aches before and during a headache attack. However, we also have a separate condition called cervicogenic headache, which are headaches that are associated with neck pathologies. I would advise you to see a specialist to have it evaluated for the exact cause. For migraine, lifestyle modifications such as staying hydrated, eating meals on time, avoiding stress and triggers, and leading a healthy lifestyle can definitely help to improve the condition. There is unfortunately no robust scientific evidence right now to show that chiropractors can help with migraine headaches.

9. Posted by E*****
Hi Dr,
My question is: For the last 12 years, every 3 years, in the months between July and Aug, for 2-3 weeks I get a massive headache; usually in the late afternoon and increasingly so this time, in the night. I noticed it almost always occurs after taking alcohol but not necessarily so as well. 
Appreciate your advice.

Answered by Dr Zhao :
Dear E*****,
There may be a specific headache syndrome that fits the description of your headache. However, I would advise to see a specialist to have it formally diagnosed and treated. From your description, it appears that the headache impacts your life significantly during the period that it happens, and medical treatment should be able to help with that.

10. Posted by F********
Dear Dr Zhao,
I started to have Migraine when I was 32 years old. It occurred almost every month before or after my menses, it usually last for 3-4days, the pain is on my right n I will vomit badly. ( I usually avoid taking pills unless I can’t tolerate) In my 40’s it is better in a sense that it recovered faster n at intervals, meaning I can still get up n go to work n maybe when I come home, the pain will come back. I realised that I also have migraine when I travel(usually 1 day after I landed) I am menopause now, thot it’s due to hormonal but it still occur. In my earlier 50’s it seems better, once in 2-3 months. I am 55 now, these 2 years, the pain is around The Eye socket n I need to take pain killers Anarex.
Looking forward for your advice.

Answered by Dr Zhao :
Dear F*******,
It is true that migraine can be triggered by hormonal fluctuation. Studies show that the prevalence of migraine amongst female increases with menarche and decreases after menopause. However not all female becomes migraine free after menopause and patients may still suffer from significant migraine attacks. While migraine cannot be cured, it can be managed with identifying the headache triggers and living a healthy and routine lifestyle. If the headache is still significantly affecting you, I would suggest that you seek medical treatment to help with managing the migraine and its impact on your life. 

11. Posted by B******
Good morning Dr, 
Why do we get headache hen we are under the sun. This hinders my long walks in the afternoons. Thank you.

Answered by Dr Zhao :
Good morning B******,
Depending on the cause of the headache, primary headache such as tension type headache and migraine can be triggered by temperature changes or extreme temperatures. It is a relatively common trigger in sunny Singapore. I do advise my patients who face such problems to do simple lifestyle modifications such as wearing a cap/hat, or to carry an umbrella when travelling out in the hot sun. 

12. Posted by G*********
Dear Dr Zhao,
I started I'm in my early 40s. Is it a call for concern if I have throbbing migraines at a specific spot (left side, about 2 inches above ear) for about the past 7-8 years. It happens 2-3 times a month, lasting for at least half a day to a day each time it occurs. I will vomit occasionally during the migraine attacks. There is no increase in either frequency or intensity these few years, and it usually occurs the moment I wake up in the morning. Panadol, Synflex and Celebrex doesn’t seem to make the headache significantly less painful. I have no other medical issues. Thank you.

Answered by Dr Zhao :
Dear G*********,
While some of the features you describe do fit the description of a migraine headache, there are still certain aspects that are cause for concern. I suggest that you see a specialist to have it properly evaluated.

13. Posted by J*******
Hi Dr,
I have been having a pounding kind of headache recently. I took Panadol and the headache subsided only for an hour or less. Can you advise what are the causes for this headache? I do not normally have headaches in my 60 years of age. Thank you.

Answered by Dr Zhao :
Dear J******,
I note that you say you normally do not have headaches in your 60 years of age. Generally speaking, if there is a new onset of headache after the age of 50 years old, we would usually advise the person to see a doctor to have it properly evaluated. 

14. Posted by s******
Dear Dr Zhao, 
I have migraines with aura; symptoms such as temporary visual disturbances, intense pain on one side of my head, and sensitivity to light and sound. The frequency of my headache is once every 2-3 months. Before the migraine onset, I will see various shapes, bright spots, light flashes and visual loss. 
When should I be concerned and see a neuro? I have been having this for a few years.

Answered by Dr Zhao :
Dear S******,
The symptoms that you have described may be seen in migraine with aura. However, further details are still needed to exclude red flags and ensure there is no underlying pathology causing your symptoms. 

15. Posted by V*****
Dear Dr Zhao
My 11-year-old son had been having frequent migraine lately.
He would be feeling so tired and would also vomit when migraine comes on.
As I also have a history of migraine since I was a young child, I would like to know if this could be hereditary.
Please advise on the treatment for children (I had not been giving him any medication as I am not a big fan of painkillers). Thank you.

Answered by Dr Zhao :
Dear V*****,
Migraine do tend to run in the family, especially in first-degree relatives, and family history of migraine is one of the aspects we evaluate during the clinical consult. We understand that pharmacological treatment is usually not favored amongst parents for their children with migraine. If migraine is formally diagnosed in a pediatric patient, we usually advise for headache trigger identification and lifestyle modification as one of the very important components of migraine treatment. Lifestyle modification includes eating a balanced healthy diet, staying hydrated, sleeping well and having a routine lifestyle. A headache diary can be utilized to identify the common headache triggers specific to the child and avoiding them.

16. Posted by n*****
Dear Dr Zhao, 
Apart from the occasional migraine attacks due to poor neck posture, I almost always have migraine the day before I have my period. 
My migraine would start with extreme fatigue, and when it is full blown, I would rate my migraine pain intensity at about 8/10, by then I will be non-functional, feeling nauseas, sometimes throwing out, very sensitive to light, smell and noise. At this stage I'll need to sleep about 8-12 hours to recover. I do not take any medication or painkiller. 
Question 1. What can I do to prevent this rather predictable migraine before the period? I tried to drink plenty of water, but apparently it didn't help. 
Question 2. The pain always starts from my left temple which spreads to behind my eyes and then numbing the whole face. Should I go for checks in case there is any growth on the left side of my head? 
Thank you Doctor

Answered by Dr Zhao :
Dear n*****,
Thank you for your questions. For female patients with migraine, they can have a condition called menstrual-related migraine. We would generally advise that the individual maintain a healthy lifestyle during that period including good quality sleep, hydration, exercise and avoidance of other known migraine triggers. However, if the symptoms persist, we can consider migraine preventive medication for the patient after assessing them clinically.

Some patients with migraine may also have aura symptoms which include visual disturbances, paraesthesia and numbness. This requires an assessment by a doctor before such diagnosis is made. For your situation, I recommend seeing a doctor for evaluation.

17. Posted by S*****
Hi Dr. Zhao,
Good day to you. I have inexplicably been experiencing tightness/pain on the right side of my neck for the past month, stretching to my right shoulder, which often escalates into headaches, then bringing forth blocked/runny nose.
Also have been feeling weakness on my left arm, easily getting numb, even when lying down. Unsure if these are related are separate issues. Can you kindly advise the best course of action to take, if any.
Thank you.

Answered by Dr Zhao :
Dear S*****,
Thank you for your question. There is a condition called cervicogenic headache that can cause neck aches and headaches concurrently. However, your symptoms appear more complex than that and it is hard to diagnose without clinical assessment. I will advise you to see a doctor to get a proper evaluation for your symptoms.

18. Posted by P********
Dear Doctor Zhao,
I had tinnitus since 27/3/2020. ENT prescribed TEBONIN Gingko biloba 1 tablet 120mg a day. Taken Tebonin on 3/3/2021, I ate 4 days. headaches started. So I stopped Tebonin Gingko.
Having this headaches since 3/3/21 at localised at top of head, behind head and left bottom of head. It's worse under hot sun. It happened every day. 
Beginning, I felt a itchy tinglish sensation on top of head. But since July 2021 in the morning felt a pressure behind head when woke up. It's worse when office aircon blow directly on my head.
On 10/5 I had a thunder like headaches strong intense pain on top of head. I went to A&E. Taken urgent MRI 11/5. I had Brain MRI done Jan2021 before. Doc then refer me to another internal brain nerves pain doctor. 7/9 my doctor appointment. 
MRI show small 0.9 cm small pituitary lesion. Does it cause headaches?
Does 120 mg Gingko Tebonin brand causes headaches?
Thank you.

Answered by Dr Zhao :
Dear P********,
I can see your concern in view of the temporal sequence of events. However, there is currently no robust evidence to suggest that consumption of gingko can cause headache. In relation to the pituitary lesion, depending on its cause, symptoms can be very varied. I will advise that you continue the follow-ups with your current doctors.

19. Posted by R**
Hi Doctor,
I just want to know why my mother in-law, who is staying with my x- husband n his wife n maid, always complain of headache? She is 86.
Thank you.

Answered by Dr Zhao :
Dear R**,
Causes of headache in an elderly patient can vary widely. If there is a new onset of headache after the age of 50 years old, we would usually advise the individual to see a doctor to have it properly evaluated. 

About Dr Zhao Yi Jing

Dr Zhao Yi Jing is a Consultant from the Department of Neurology at NNI, who specialises in the assessment, treatment and prevention of headaches and migraines. Dr Zhao is the principal investigator for the Singapore representative in several international and local trials involving novel therapy for headache. She also sits on medical advisory boards for new migraine treatments in Singapore.

Because #healthiswealth #healthforgood

Ref: K21