My sister-in-law Mary Chong Lee Moy who is recently a just retired Senior Nurse Clinician at the National University Hospital in Singapore phoned me this afternoon from Johor Bahru complaining about her migraine.
Let me take this opportunity to share my advice to her with other migraine sufferers too, especially for women reaching their menopause.
Professor Dr SC Ling in a WhatsApp group also encouraged me to post this advice here so that others too can benefit
Below is what I spoke to my sister-in law orally over the phone
Migraine Management & Relief
Dear Mary,
Thank you for reaching out to me regarding your migraine concerns. I'm grateful for the opportunity to offer some support. Migraines can be complex and vary from person to person, but there are both immediate and long-term strategies that may help you manage them effectively.
Immediate Relief with Cold Compress Therapy
Applying cold compresses to both sides of the neck, forehead, and back of the head can be helpful in managing migraine pain. Cold therapy offers multiple benefits:
Vasoconstriction: Cold compresses narrow the blood vessels (especially the superficial carotid arteries), which may help counteract the vasodilation involved in migraines.Apply for 15–20 minutes at a time, up to 4–6 times daily as needed.
Avoid direct ice contact to prevent skin burns.
Complementary Non-Drug Therapies
In addition to cold therapy, consider:
Meditation and mindfulness breathing (especially diaphragmatic breathing)Progressive muscle relaxation (PMR)
Yoga for migraine (specific poses help relieve cervical tension)
Hypnotherapy: Clinical hypnosis can reduce stress-induced migraines. Some trials have shown reduced frequency and severity with consistent sessions
Acupuncture: Evidence supports its role in chronic migraine prevention
Avoiding Common Migraine Triggers
Lifestyle and environmental triggers are significant in migraine management. These include:
Environmental Triggers:
Bright or flickering lights (including sunlight through tree leaves).Strong odors (smoke, perfume)
Noisy environments
Skipping meals or irregular sleep schedules.
Dietary Triggers (to avoid)
Aged cheese (tyramine content)
Red wine and other alcoholChocolate (phenylethylamine)
Processed meats (nitrates/nitrites)
Caffeine: For some, it relieves migraines; for others, it triggers or worsens them, especially with sudden withdrawal.
It’s helpful to keep a migraine diary to track and identify individual food and lifestyle triggers.
Herbal and Natural Supplements:
Several herbs may help reduce the frequency or severity of migraines. However, dosage, purity, and drug interactions must be considered.
Feverfew (Tanacetum parthenium):
Mechanism: Reduces inflammatory prostaglandins, serotonin release, and platelet aggregation.
Dose: 100–300 mg daily of standardized extract (with 0.2–0.4% parthenolide).
Avoid during pregnancy.
Butterbur (Petasites hybridus):
Mechanism: Anti-inflammatory, antispasmodic on vascular walls.
Dose: 75 mg twice daily of PA-free (pyrrolizidine alkaloid-free) extract.
Not recommended for long-term use due to possible liver toxicity.
Ginger:
Useful for nausea and vomiting during migraine attacks.
Can be taken as tea, capsules (250 mg), or raw ginger.
Melatonin:
Mechanism: Regulates circadian rhythm; modulates serotonin.
Dose: 3 mg at bedtime.
Especially useful in migraines with sleep disturbances or hormonal links.
White Willow Bark:
Contains salicin (like aspirin).
Dose: 120–240 mg salicin/day.
May be beneficial for general headache and pain relief.
Aromatherapy & Oils
Lavender oil: Inhalation or massage (2–3 drops diluted in carrier oil) may relieve migraines.
Peppermint oil: Apply diluted oil on temples or forehead for tension headache relief.
Conventional Migraine Medications
If migraines become more frequent or disabling, the following may be considered under a physician’s supervision:
Acute Migraine Relief:
Paracetamol (Acetaminophen): 500–1000 mg at onset.
NSAIDs: Ibuprofen 400–800 mg or Naproxen 500 mg.
Triptans (for moderate to severe attacks):
Preventive Therapy (if >4 attacks/month):Beta-blockers: Propranolol 40–120 mg/day.
Calcium channel blockers: Verapamil.
Tricyclic antidepressants: Amitriptyline 10–75 mg/day.
Anticonvulsants: Topiramate (25–100 mg/day), Valproate.
These should be prescribed after full assessment.
Caution with Herb–Drug Interactions
Feverfew may interact with NSAIDs or warfarin (increased bleeding)Butterbur and melatonin may interact with liver-metabolized drugs
Herbs may affect the action of triptans, beta-blockers, antidepressants, and anti-seizure medications.
Always consult a healthcare provider before starting herbal supplements, especially when taking conventional medication.
Please let me know how you feel after trying the cold compress therapy alone. If it helps even partially, it’s a good sign. Then you may proceed to trial feverfew and melatonin or butterbur, depending on your tolerance and medical history.
You are not alone in this. Migraine is a complicated but manageable condition. Let us work together to explore the best strategy that suits your unique case.
As a care-giver, I am one who sees beyond pills into the person.
Take care always, dear Mary. I’m here anytime you need me.
With blessings, and brotherly love
lim ju boo
(Articles yet to come in this blog):
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