A new migraine treatment in Malaysia both treats and prevents attacks
Pain can result in huge disability, as evident from the fact that migraine was the second leading cause of disability worldwide, according to the Global Burden of Disease study in 2019.

It can have a big impact on productivity as its numbers peak in the prime working age group of 30-39, according to a 2007 study in the medical journal Neurology.

This is as the headaches can last for hours to days if left untreated, and can be accompanied by other symptoms like sensitivity to light (photophobia) or sound (phonophobia), nausea, dizziness and vomiting.

Consultant neurologist Dr Julia Shahnaz Merican adds: “It’s a young person’s disease – it can start from the age of five right up to 16.”

One characteristic of a migraine is that it will strike again.

The vast majority of patients (92%) have episodic migraines, which occur less than 15 days in a month.

The other 8% have chronic migraines, which feature either tension-type headaches or migraines for more than 15 days a month for more than three months, with migraines occurring more than eight of the days per month.

That is why treatment is divided into stopping the pain (acute) and preventing the pain (prophylactic).

Acute treatment usually consists of painkillers (analgesics) such as paracetamol and/or non-steroidal anti-inflammatory drugs (NSAIDS, e.g. ibuprofen) for mild to moderate migraines.

Another effective option are the triptans, which are migraine-specific medications that block a specific pathway that results in pain during the attack.

Rimegepant, which is a calcitonin gene-related peptide (CGRP) antagonist, can also be prescribed to treat a migraine attack.

Recently approved for use in Malaysia for adults (January 2024), this drug also uniquely works to prevent a future migraine attack.

The patient must take the once-a-day oral dissolving tablet (i.e. it will dissolve in saliva when placed in the mouth) every other day for this to work.

Other groups of medications commonly used to prevent migraines include blood pressure-lowering medications (e.g. propanolol), anti-depressants (e.g. amitriptyline), anti-seizure drugs (e.g. sodium valproate) and a CGRP antagonist monoclonal antibody called erenumab.

While there are other drugs available for the treatment of migraines, some are not currently approved for use in Malaysia.

Patients can also try non-pharmacological methods to manage their migraines, with the most important one being identifying and avoiding their migraine trigger(s).

Common triggers include stress, hormonal changes (especially for women, who are three times more likely than men to suffer from migraines), alcohol, certain foods and changes in the weather.

Patients can also try acupuncture, relaxation techniques, biofeedback, cognitive behavioural therapy (CBT) and living an overall healthy lifestyle, among other methods.

Based on her experience, Dr Julia notes that many Malaysian patients will put up with a mild headache for hours, only taking a painkiller like paracetamol when the pain is “10 out of 10”.

“But my philosophy is, you get it to zero with something that works,” she says.

“I tell people to take (medication) when it’s at three, four, five, so you get a better chance of going to zero; instead of from 10, you stay on five for the rest of the day.”

To qualify for preventive treatment, patients should be experiencing migraines more than four days a month.

Says Dr Julia: “We try and reduce disability; we try and prevent them from being hospitalised for migraine, so uses less cost for the healthcare system.

“But it requires compliance, knowledge, willingness to take whatever the medicine I want them to take.”

She adds that patients cannot just take a preventive medicine for one day, or even one month, and expect to see an immediate improvement.

“You have to persist, and then there will be change,” she says.
Wellness,Migraine,treatment
Other available medications either only treat the attack or prevent it.