Did you know that the National University Hospital (NUH) reported that they receive 100 new patients at the patient referral clinic for headache disorders every month¹? Additionally, the lifetime prevalence of headaches in Singapore has been reported to be a whopping 82.7%. These numbers are quite startling and begs the question of why the occurrence is so common here in Singapore.
In a separate study, stress has been found to be a common trigger for tension-type headaches². Coincidentally, Singapore reports a high-stress level³ and reportedly spends about US$2.3 billion or 18% of its total annual healthcare expenditure on stress-related illness such as headaches.
So what can we understand about headaches and how do we treat them besides popping painkillers? We speak to Dr Wee Chee Keong, Senior Consultant Neurologist and Founder of Capernaum Neurology to find out more.
Q: How does the headache population look like in Singapore? Have you noticed an increase in patients with headaches and what are they usually triggered by?
Dr Wee: In Singapore, the lifetime prevalence of a headache is reportedly 82.7%, which is a vast majority of us here. At my clinic, about 20-30% of my patients seek medical help with their headaches or migraines. These are typically triggered by work, relationship and financial stressors.
Q: Do you think the pandemic has an impact on headache numbers in Singapore?
It is possible for the pandemic to have contributed to some of the headache numbers in Singapore, seeing as stress is a common trigger for most headache occurrences. There are many factors that many may experience as a result of the pandemic that could have led to stress. Whether it’s increased screen time, working from home or heightened anxiety levels because of the impact of the virus, these hold the potential to increase stress levels and it can increase the frequency for headache attacks.
However, this is also very subjective and it is difficult to say for sure that the pandemic has caused more headache occurrences. It is not a one-size-fits-all model and many factors come into play when it comes to headaches.
Q: Walk us through the different types of headaches and how each type would affect an individual? Do they differ in different pain degrees?
A headache is a symptom and it is typically identified by pain from the neck up. It can come in different forms and the triggers and symptoms for each type of headache can vary. Generally, there are three overarching types of headaches. In increasing degrees of pain, these include:
- Tension Headache – These are the most common type of headache, and its symptoms can last hours or days and cause pain with tight, constant pressure on the head, neck, or forehead from muscle contraction. Common triggers for tension headaches include stress, anxiety, lack of sleep, jaw clenching and missed meals.
- Migraine – A migraine is a severe headache that are can last for hours or even days, if left untreated. Symptoms of a migraine could include throbbing localised pain, sensitivity to light, sensitivity to sound, nausea and vomitting. Triggers for a migraine also include stress, anxiety, hormonal changes, bright/flashing lights, lack of food, lack of sleep, and certain dietary substances. Migraines are usually considered as a neurological condition and patients should consult a doctor if they think they have a migraine.
- Cluster Headache – The highest severity for headaches are known as a cluster headache and these are a uncommon type of headache. Such headaches are intense, and can occur several times a day with each episode in ‘cluster periods’, often felt around the eye, like a stabbing pain behind or around it, usually on one side. Smokers or those who drink a lot are at an increased risk of cluster headaches. Symptoms for these include congested nasal pathways, tearing, a running nose, facial and forehead swelling, constriction of pupils and eyelid swelling. Similar to migraines, these are neurological conditions that will require medical attention.
Q: Is it true that women are more susceptible to headaches? Why is this so?
Research has shown that females are generally more susceptible to headaches and for a longer period at each time4. Likewise for migraines, women are also twice as likely to suffer from migraines compared to men, globally. According to that same study, changes in hormones could play a part in the contributing to headaches.
Q: How can headaches be treated?
Depending on the severity, headaches can be resolved on their own while some may require medical advice/attention. For mild to moderate headaches, lifestyle changes such as incorporating intentional time away from work, relaxation techniques or yoga can help to ease the pain in the head. For pain relief, patients can also opt for over-the-counter medication like paracetamol to render relief to the pain.
For severe headaches, do seek medical attention. From there, doctors will observe and plan a program to treat the ache.
Many of the medications we use to treat headaches have the potential to cause drowsiness . As such treatment is highly individualised and tailored according to the patient’s lifestyle and work commitments. Whatever the treatment utilised, patient education on the headache type and abortive measures used is central to successful headache treatment.
Q: A lot of people may opt to use painkillers, or paracetamol, to treat headaches. Is this recommended and is it recommended for extended use for people with regular headache occurrences?
Yes, for mild to moderate headaches, paracetamol can help to temporarily ease the pain. The medicine is one of the most commonly used pain relievers globally and has few reported side effects. It is safe for consumption and can help to support with bringing comfort to pain from headache symptoms.
Dosing paracetamol, however, should be done with caution in order to avoid overdosing, and it should only be taken as needed. Ensure to read the product information to understand the recommended dosage of the paracetamol brand5. If it is unclear on how to administer the product on own, always seek the advice of a healthcare professional.
Q: Are there any indicative signs/symptoms that require attention from a doctor?
If the occurrences continue to worsen, it is important to seek immediate medical attention as some headaches may also signal a life-threatening condition. When accompanied with a severe headache, seek medical attention immediately if any of the warning signs below are experienced:
- High fever
- Nausea, vomiting
- Sensitivity to light
- Stiff neck
- Sudden explosive headache ( thunderclap)
- Impairment of speech, vision or movement
Q: What can one do to prevent or manage headaches?
With stress identified as one of the key triggers for headaches, it is important to identify where the stress stems from and seek support if needed. If stress levels increase and it leads to headaches that impact daily living, do seek medical advice.
Other helpful tips to manage headaches include:
- Regular physical activity
- Sufficient rest
- Controlled screen time to reduce eye strain
For severe headaches like migraines or cluster headaches, do consult a medical professional immediately.
¹ Migraine is a billion-dollar headache for Singapore, nationwide study finds
²Tension-type headache, its relation to stress, and how to relieve it by cryotherapy among academic students
³Are You Part Of The 92%?
5Examples of Paracetamol brands include Tylenol