Back to work with a migraine – and Chinese New Year could make it worse

Food-related triggers of migraine are seen in about 10 per cent of migraine sufferers, said Dr Ong, and the food or ingredient varies widely from person to person. Nevertheless, the common ones are those that contain certain chemicals that may potentially set off a migraine.

For instance, preserved meats, including waxed duck, lup cheong and bak kwa, are sources of nitrates. These substances dilate blood vessels, triggering headaches in some people. And nitrates aren’t just limited to meat. 

The tray of dried fruit, nuts and seeds typically served to house guests during CNY visits is also high in nitrates, as are other preserved food such as smoked or dried fish, and pickled food, including preserved beancurd.

• Avoid MSG

Many people already avoid monosodium glutamate (MSG) in their food, but the dishes served up for reunion dinner in restaurants may contain it as MSG is a commonly used flavour enhancer. It is also used in soya sauce and meat tenderisers, said Dr Ong. 

According to the Cleveland Clinic website, migraine symptoms may begin 20 to 25 minutes after consuming MSG.

• Watch your alcohol and Chinese tea intake

Alcohol such as red wine, beer, whiskey and champagne may contain a preservative known as sulfites, which could elevate inflammation levels and lead to migraine. Alcohol can also dehydrate you and that can also contribute to the risk.

Caffeine is another factor. And while you may avoid known sources such as tea, coffee and cola drinks, note that Chinese tea is also a caffeine source, albeit a lower one. Comparatively, an eight-ounce cup of coffee has about 90mg to 200mg of caffeine, while the same amount of Chinese black tea has about 40mg to 70mg of caffeine. 

But don’t go cold turkey on your caffeine intake as the sudden withdrawal may provoke a headache, said Dr Ong.

• Minimise stress

You’re prepping for a red-eye flight out of town for a last-minute CNY getaway. Or you could be shopping for new clothes and household items, coordinating reunion dinner booking for the entire extended family… And you haven’t even started cleaning yet.

To fit everything into your to-do list, you often end up stressed and not hydrating sufficiently. You sleep less, and you eat irregularly – a combination that can trigger a migraine, said Dr Ong. It helps to pay close attention to these factors to minimise the chances of an attack, he said. 

• Avoid loud events such as lion dance performances

Although migraine patients tend to be more sensitive to environmental stimuli, only a small proportion of them get an attack caused by triggers such as bright or flickering lights, extremes of heat, loud sounds, and intense odours or smells, including cigarette smoke, said Dr Ong. 

But once a migraine starts, many patients may find these environmental stimuli as unbearable as the pain. “Patients who are actively having a migraine attack, and those who are prone to developing headaches under these circumstances should avoid these scenarios as much as possible,” said Dr Ong.

WHEN SHOULD PREVENTIVE MEDICINE BE CONSIDERED?

At National University Hospital’s (NUH) outpatient clinic, about 1,250 new migraine cases are seen each year, said Dr Ong, who is also a consultant at NUH’s Division Of Neurology.

“A migraine episode can last from a few hours to more than a day, and many patients are unable to function at their full potential at work or school. When attacks are frequent, they impair the patients’ quality of life and many lead inhibiting lifestyles for fear of triggering the next attack,” said Dr Ong.

Migraine sufferers are all-too-familiar with the moderate to severe headaches that come with each episode. They can sometimes be accompanied by sensitivity to light, sounds and smells as well as nausea and vomiting.

A few days before a migraine attack, patients may experience pre-symptoms such as low energy, frequent yawning, neck and shoulder stiffness, food cravings, irritability and/or depression.

This usually means relying on painkillers, or trying to sleep it off in a quiet, dark room. But what if you could prevent a migraine before it even begins?

Since the approval of Aimovig (generically known as erenumab) by Singapore’s Health Sciences Authority last November, adult patients can add this preventive option to their arsenal.

First, the science. During a migraine attack, a protein known as calcitonin gene-related peptide or CGRP is released in large quantities by the body. When the protein attaches to its corresponding receptor in the meninges or coverings of the brain, it causes inflammation and pain transmission that give rise to a migraine.

The once-monthly injectable Aimovig works by capping the receptor, so even when the CGRP protein is floating around in the body, it can’t attach to it. According to manufacturer Novartis, this is the first preventive treatment in Singapore that blocks a receptor that transmits pain signals. It was approved for use by the US Food And Drug Administration last May.

It isn’t the only migraine preventive medicine available. However, most of the other medicines were created to treat other health issues such as high blood pressure, depression and epilepsy, according to Science News. 

They also come with severe side effects, including extreme drowsiness and brain fog. Comparatively, Aimovig’s side effects, including constipation, cramps, and/or redness or pain in the injection site, seem more tolerable for long-term use.

“Preventive treatment is used when the frequency and intensity of the attacks justify the cost, inconvenience and possible side effects of the treatment,” said Dr Ho King Hee, consultant neurologist at Gleneagles Medical Centre.

“As a rule of thumb, seven days of pain a month, or two to four attacks a month would be an indication that preventive treatment needs to be given.”

Generally, it may take preventive medicines two to three months before you notice a decrease in the frequency or severity of attacks – even after reaching the “beneficial dose”. And the treatment may be required for six to 12 months or longer.

Novartis did not comment how much each shot of Aimovig costs in Singapore. But it has been reported to set patients back by US$6,900 (S$9,413) a year in the US.