You've got a pounding headache and you don't feel like getting out of bed. You reach out for your phone to call in sick, but think, "Eh, can get MC or not ah?"

Before you tell your boss that you'll be on medical leave, it's best to see a doctor first because according to Dr Jonathan Ong, President of the Headache Society of Singapore, "Not all patients will be categorically granted medical leave during a migraine attack if they consult a doctor."

He says, "This depends on the patient's condition and the assessment of the attending physician. If a patient is having a severe migraine attack and has significant symptoms rendering him or her unfit for work, the doctor may certainly grant a medical certificate for the patient to fully recuperate before returning to the workplace."

SO WHAT CAN YOU DO IF YOU DO HAVE A MIGRAINE AT HOME OR AT WORK?

He suggests finding a calm environment and retreating from your usual activities at the first sign of a migraine attack.

He also recommends turning off the lights because "during a migraine attack, there is often increased sensitivity to light and sound." He adds that you should relax in a dark, quiet room and sleep if you can.

You can also try applying hot or cold compresses to your head or neck-ice packs can dull the sensation of pain while hot packs can relax tense muscles.

Another treatment is to take analgesics as early as possible when you're experiencing mild pain.

"Many tend to adopt a 'wait-and-see' approach and consume analgesics later in the course of their attack when the pain intensity is more severe.

"This is a misconception as delayed administration of acute medication leads to a more unsatisfactory effect. In addition, many experience nausea or vomiting. Thus medication taken later in the course of an attack may not be absorbed by the gut," says Dr Ong.

Apart from taking medication - whether pain-relieving or preventive ones - he suggests making changes to one's lifestyle, avoiding triggers and leading a healthy lifestyle to prevent migraine attacks.

"The treatment strategy depends on the frequency and severity of headaches, the degree of disability caused by the headaches, and other concomitant medical conditions."

One way to find out or identify your trigger is to keep a detailed headache diary.

"Trigger factors can influence an attack up to 48 hours before a headache comes on.

A diary can help patients to look at this period before each attack, and a noticeable pattern may emerge linking possible triggers with the occurrence of migraine headaches," he says.

Read on to find out the common triggers, according to Dr Ong.

STRESS

Migraine and stress have a strong link. Anxiety, excitement and any form of tension may all lead to a migraine attack. However, some people report that their migraine attacks start when the stress reduces.

This is sometimes experienced as "weekend headaches" because after a busy and stressful week at work, the individual might experience a migraine when they are more relaxed during the weekend.

SLEEP

Too much and too little sleep can result in a migraine. Some people find that sleepless nights, a number of late nights and being over tired can trigger a migraine. Other people find that over-sleeping has the same effect.

CAFFEINE

Excessive consumption of caffeine may contribute to the onset of a migraine attack. Limit the intake of caffeinated drinks to no more than four or five cups of tea, coffee or cola in a day.

Some find that suddenly stopping caffeine altogether can also be a trigger. If you suspect this to be your trigger, gradually cut down on caffeine.

Others may find that consuming less caffeine at the weekend can have an impact on migraine attacks.

HORMONAL CHANGES IN WOMEN

Migraine is closely associated with female hormones. Some women find their migraines start at puberty, and are linked to their menstrual cycle.

The additional hormonal trigger for women may explain why more women than men experience migraine during their reproductive years.

Menopause is often the most difficult time for women with migraine due to fluctuating hormonal levels.

THE ENVIRONMENT

There are certain trigger factors, which can be related to environmental issues such as weather changes, high humidity, loud noises, exposure to glare or flickering lights.

COMPUTER SCREENS

Sitting in front of a computer for long periods of time can cause problems if you have a migraine. Taking regular breaks, using anti-glare screens and having good lighting can help prevent this.

Good workplace sitting ergonomics is very important when you use a computer to avoid muscle tension building up in the head, neck and shoulders. This muscle tension can result in the onset of migraine.

ADDITIVES

Some food products contain chemicals or additives which may also be implicated in an attack. Ones that are frequently mentioned by people with migraine are monosodium glutamate, nitrates and aspartame.

FOOD

Food-related triggers occur in about 10 per cent of people with migraine.

Many people will crave sweet foods such as chocolate before they experience the pain of the migraine, which leads them to conclude that eating sweet food is a cause.

However, sometimes, the craving for particular food is a symptom of the beginning of the migraine.

LACK OF FOOD

Missing meals or eating sugary snacks instead of a balanced meal can all contribute to a migraine attack. Insufficient food is probably one of the most important dietary triggers.

Eating small snacks at regular intervals can help to control your attacks.

ALCOHOL AND CHEESE

There is some evidence that red wine may trigger a migraine because it contains tyramine, which has been linked to migraine. Tyramine is also found in other food products such as soft cheeses.

DEHYDRATION

Dehydration can have an impact on people who have migraine. Consume at least eight glasses of water a day to remain hydrated. Carbonated drinks can contain the sweetener aspartame, which some people link to their migraine.

EXERCISE

Like sleep, exercise can both help to prevent migraine and conversely, can be a trigger factor for some people. Regular exercise which is built up gently can help to prevent migraine.

It also stimulates the body to release its own natural painkillers, as well as increasing the individual's sense of well-being and general health.

Sudden vigorous exercise, particularly for people who do not usually take exercise, can be a trigger.

BUT... A MIGRAINE IS JUST A HEADACHE, RIGHT?

Nope.

"A migraine is more than just a headache. It is a recurrent disorder with a wide array of symptoms. For many, the main feature is a painful headache," says Dr Ong.

He describes migraine attacks as "often very disabling and may result in one having to lie still for several hours". It usually lasts from four to 72 hours, although you might feel well in between attacks.

Another reason why it's more than just a headache: there's a possibility you might develop a migraine complication, which includes stroke - migraineurs have approximately twice the risk of having a stroke - and migrainous infarction, a rare complication that mostly affects younger women.

"This condition always occurs with an aura (a set of unusual phenomenon like flashes of light, visual disturbances, and tingling of the hands or face) that lasts for more than 1 hour in duration. Symptoms such as limb and/or facial weakness or numbness, slurring of speech or gait unsteadiness occur suddenly and is an emergency.

"The patient develops a stroke in the area of the brain from which the symptoms of the aura originated. This stroke is seen by a doctor on a brain scan such as a MRI scan. Women under 45 who smoke cigarettes and take contraceptive pills have an increased risk of developing a stroke with migraine, especially if they have migraine with aura," says Dr Ong.

Migraines can also lead to other health issues including depression, anxiety, vertigo and sleep disorders.

WHEN DO YOU SEEK MEDICAL ATTENTION FOR MIGRAINE?

You should seek medical attention if the headache you are experiencing is different from previous migraines - and yes, you can experience other headaches even if you have been diagnosed with a migraine.

"Some headache features are considered 'red flags', in that the symptoms and signs are indicative of a serious underlying cause for the headache.

Physicians often use the acronym 'SNOOP4" to help recall headache 'red flags'.

It is reasonable to seek medical attention if a headache is different from the typical migraine and is associated with one of the following 'red flag' features," says Dr Ong. He outlines the red flags below.

S: SYSTEMIC SYMPTOMS & SIGNS

Consult a doctor if you have: headaches accompanied by fever, neck stiffness, vomiting or rashes; headaches associated with an underlying bleeding disorder, underlying cancer diagnosis or underlying immune-compromised state (HIV/AIDS), or headache after recent head trauma.

N: NEUROLOGIC SYMPTOMS & SIGNS

If you have headaches that associated with neurological signs or symptoms such as seizures, trouble with vision, clumsiness, impairment in strength on one side, impairment in level of consciousness or persistent vomiting, seek medical attention.

O: ONSET SUDDEN

A sign that you need medical attention: if you experience headaches that are sudden and explosive, reaching maximum intensity within one minute.

O: OLDER PERSON

Anyone who develops his or her first headache over the age of 50 years should seek medical attention. If, however, you are experiencing your typical migraine, but happen to be over the age of 50 years, medical attention is not necessary.

P: PREVIOUS HEADACHE HISTORY (NEW/FIRST/WORST/DIFFERENT/CHANGE)

Seek medical attention if you're experiencing headaches that have changed from a prior headache type, the worst headache in of your life, your first severe headache, or headaches that are progressively more frequently, severe in intensity, or persistent despite medication.

You should also seek medical attention if you are unable to cope with the pain, or if a new headache causes you to wake from sleep.

P: PRECIPITATED BY VALSALVA

If you experience headaches that are made worse by bearing down, coughing, sneezing, exertion or sexual intercourse, consult a doctor.

P: POSTURAL HEADACHES (UPRIGHT OR LYING FLAT)

Consult a doctor if you have headaches that are consistently worse in the morning or when lying flat. You should also seek advice if you have headaches that are consistently worse when sitting or standing up and relieved when lying flat.

P: PREGNANCY OR POST-PREGNANT STATE

Have severe or new headaches developing during and post-pregnancy? Seek medical attention.

This article was first published in CLEO Singapore.