Headache and migraine teleconsult in Singapore
Most headaches are tension-type or migraine and respond well to a short, structured plan combining over-the-counter analgesia, hydration, sleep and — for migraine — a triptan when needed. A teleconsult is well-suited to recurring familiar headache patterns. Sudden, severe or neurological headaches need same-day in-person review.
What is headache and migraine?
Headache is one of the most common reasons adults seek primary care in Singapore. The vast majority are primary headaches — tension-type headache, migraine, or cluster headache — which are not caused by another underlying disease. Tension-type headache is the commonest, presenting as a bilateral pressing or tightening pain of mild-to-moderate intensity, often after long screen hours, poor posture or stress. Migraine is typically a one-sided throbbing pain of moderate-to-severe intensity, lasting 4 to 72 hours, often with nausea, vomiting, light or sound sensitivity, and sometimes preceded by an aura.
Secondary headaches — caused by another medical condition — are much less common but can be serious. They include subarachnoid haemorrhage (sudden “thunderclap”), meningitis, giant cell arteritis (in patients over 50), idiopathic intracranial hypertension, brain tumour, or sinus / dental infection. A different pattern from your usual headaches, especially with neurological symptoms, fever or recent head injury, warrants in-person assessment.
What commonly causes it
- Tension-type headache — most common; triggers include stress, posture, screen fatigue, dehydration
- Migraine — usually genetic predisposition; triggers include sleep changes, missed meals, hormones, alcohol, MSG
- Medication-overuse headache — paradoxical headache from taking analgesics on 10+ days/month
- Cluster headache — strictly one-sided, severe, around the eye, with tearing and nasal congestion
- Sinus headache — facial pressure with nasal congestion or purulent discharge
- Cervicogenic headache — referred from neck strain, common in office workers
- Caffeine withdrawal — usually 12 to 24 hours after the last cup
- Secondary (serious) — SAH, meningitis, giant cell arteritis, brain mass, idiopathic intracranial hypertension
When teleconsult may be suitable
- Recurring tension-type headaches in an otherwise well adult
- Migraine in a patient with a previous diagnosis and familiar pattern
- Medication advice for prevention (propranolol, topiramate, amitriptyline) or acute relief (triptans)
- Review of medication-overuse headache and structured withdrawal plan
- MC assessment when headache or its medication side effects affect work
When to seek in-person care
- Sudden, severe headache reaching peak within seconds to a minute — “thunderclap” — possible subarachnoid haemorrhage
- Headache with fever, neck stiffness, rash, photophobia — possible meningitis
- Headache with neurological symptoms — weakness, numbness, slurred speech, visual loss, confusion, seizure
- New headache pattern in pregnancy or in patients aged 50 and above
- Headache after recent head injury, or worsened by cough, exertion, sex or lying flat
- Headache with very high blood pressure (≥ 180/120 mmHg) or with jaw claudication
- Progressive worsening over days to weeks despite treatment
What to tell the doctor
- Describe the headache pattern: location, character (throbbing vs pressing), severity 0 to 10, duration
- Note triggers, associated nausea or light/sound sensitivity, aura, and how many days per month you have headache
- Track which medications you have tried and their effect
- Bring a recent blood pressure reading if you have a home monitor
- Note any recent head injury, fever, neck stiffness, or new neurological symptoms
What you can safely do at home
- Paracetamol 1 g or ibuprofen 400 mg taken early in the attack is more effective than waiting
- Drink 500 ml of water and rest in a dark, quiet room for migraine
- Cool compress to the forehead; warm compress to the back of the neck for tension headache
- Caffeine 100 to 200 mg can abort early migraine in some patients (but avoid chronic daily use)
- Maintain regular sleep, meals and hydration — three of the most reliable migraine triggers
- Track headaches in a diary for 6 to 8 weeks to identify personal triggers
What the doctor will ask
- Is this headache new, sudden, or different from your usual pattern?
- Any neurological symptoms: weakness, slurred speech, visual changes, confusion, seizure?
- How many days per month do you have headache? How many days do you take painkillers?
- Trigger pattern, sleep, stress, caffeine, alcohol, hormonal cycle, recent head injury
- Family history of migraine, recent blood pressure readings, current medications and allergies
Frequently asked questions
Can my migraine be treated via teleconsult in Singapore?
Yes, for a familiar migraine pattern in a patient with a previous diagnosis. The doctor can prescribe acute medication (paracetamol, ibuprofen, triptans, anti-emetics), discuss prevention, and arrange same-day delivery. New severe headaches, neurological symptoms, or pattern changes need in-person review to exclude secondary causes.
When is a headache an emergency in Singapore?
Go to A&E immediately for a sudden “thunderclap” headache reaching peak within seconds, headache with fever and neck stiffness, headache with weakness or slurred speech, headache after head injury, or a brand-new severe headache pattern in pregnancy or in patients aged 50 and above.
I take painkillers most days — is that a problem?
Yes — taking analgesics on 10+ days per month can cause medication-overuse headache, a paradoxical condition where the painkillers themselves drive more headache. The fix is a structured withdrawal plan over 2 to 4 weeks combined with prevention. A teleconsult is a good place to start the plan.
Are triptans safe for me?
Triptans are safe and effective for most adults with migraine. They are avoided in patients with uncontrolled high blood pressure, ischaemic heart disease, prior stroke or TIA, severe peripheral vascular disease, and during pregnancy. The doctor will check these before prescribing.
How many days of MC can I get for migraine?
Typical MCs for a migraine attack cover 1 to 2 days. Patients with chronic migraine (15+ days/month) may need a longer structured plan including preventive medication, lifestyle review and possible specialist referral.