Yawning, food cravings, mood changes: These could be warning signs of a migraine
It starts innocently enough. You cannot shake off a sudden urge to indulge in a bar of chocolate despite having just eaten lunch; or perhaps it is the frequent yawning even after a good night’s sleep.
The day after, it strikes – one of those crippling headaches that can last up to three days and leave you feeling drained, nauseated and needing to recuperate in a quiet, dark room.
These sudden food cravings or frequent yawning could be more than isolated incidents. According to the Mayo Clinic, these and other warning signs such as a stiff neck1, unusual tiredness or even unexpected sadness could mean that a migraine episode is just one or two days away1.
It may be common practice to pop a pill and push through the pain, but this may not prevent future migraines – and over time, it could even make things worse1.
What’s the difference between headache and migraine?
According to Adjunct Associate Professor Jonathan Ong, senior consultant, Division of Neurology, Department of Medicine, National University Hospital (NUH), the above could be signs of something more than a common headache. Prof Ong is also the current president of the Headache Society of Singapore.
He explains: “A headache is a symptom, not a diagnosis2. Because migraine is a neurological condition affecting multiple brain pathways3, it can sometimes occur without significant head pain, but with other symptoms.”
“Just as an engine warning light on a car dashboard signals that something is wrong but doesn’t identify the cause, a symptom signals that there is a problem, while a diagnosis identifies the underlying cause – such as a faulty spark plug.”
Migraine commonly causes recurrent attacks² characterised by pulsating pain, sensitivity to movement, light and sound, as well as nausea and vomiting1,2,4.
Other key signs of migraine2 may include intense, often one-sided throbbing pain, visual or neurological disturbances, such as flashing lights, jagged zigzag lines, blurry patches or blind spots1, collectively known as auras2.
How common is migraine in Singapore?
In Singapore, roughly 1 in 10 adults – or around 330,000 people – are affected by migraine5, with the condition up to three times more common in women after puberty due to hormonal factors such as menstrual cycle changes, contraception or hormonal therapy6.
A local study, Economic Burden of Migraine in Singapore, estimated that migraine resulted in $1.04 billion in economic losses in 20185,7. This was mostly due to lost productivity, and the remaining 20 per cent was attributed to healthcare costs, such as medical tests and consultations. Prof Ong was one of the researchers involved in the study.
Migraine episodes can disrupt work and daily activities, but recognising the early signs may help people seek medical advice sooner (see footnote 4 and 8).
PHOTO: GETTY IMAGES
Yet migraine is often underdiagnosed, under-recognised and undertreated in Singapore, with only a proportion of patients seeking medical care, and many not receiving long-term optimal care8.
It all boils down to awareness, adds Prof Ong, citing global awareness initiatives, including Migraine Awareness Month in June9, and the work that organisations such as the Headache Society of Singapore does, which all aim to raise awareness about migraine as a potentially disabling neurological condition rather than “just a headache”.
He adds: “People need to recognise the symptoms so they know when to seek medical advice8. There is a need to raise awareness among both healthcare professionals and the general public, and significant opportunities remain for further improvement.”
Episodic vs chronic migraine: when to seek treatment
Even among people with migraine, there is a distinction between those who suffer from episodic and chronic migraines10.
Prof Ong explains that the latter, which he says affects about 2.5 per cent10 of the entire migraine cohort, means a person experiences migraine headaches on 15 or more days each month10, for more than three months.
“Chronic migraine often develops from episodic migraine when symptoms such as headache and nausea aren’t managed well11,” says Prof Ong.
That is where preventive care is key, he adds. “Early recognition and appropriate management may help reduce the risk of episodic migraine progressing to chronic migraine11.”
For people whose episodic migraine is starting to disrupt their daily life, a combination of preventive treatment4 and lifestyle adjustments4 may be recommended. For chronic migraine, preventive treatment is usually necessary to reduce both frequency and severity12, 13.
Yet in reality, however, it is not so simple, notes Prof Ong. “Migraine can be highly disabling14. A single attack may keep someone off work for days, and visual symptoms15 can be especially dangerous for people who drive or work in high-risk jobs14.”
At a glance: Recognising migraine
Here are some common features of migraine to look out for1,2.
Throbbing, pulsing pain
Usually one-sided
Moderate to severe pain
Often comes with nausea/vomiting
Sensitivity to light and sound
Lasts from 4 to 72 hours
May come with aura or other signs
Know what triggers migraine
Migraine triggers vary from person to person, but multiple triggers can combine to push someone past their threshold14 – like a cup filling until it overflows. Keeping a daily diary15 can help identify these triggers, says Prof Ong.
Stress is one of the most commonly reported migraine triggers, affecting around 70 per cent of people with migraine.16 Some people may also experience the “let-down” effect, where an attack occurs after a high-stress period17.
“The migraine brain thrives on routine,” he says. “Even taking a break from work can trigger what’s known as a ‘holiday headache’. People often assume less stress means fewer migraines, but it’s the disruption to routine18 that can trigger an attack.”
“Sleeping in, changing meal times, travelling or crossing time zones18,19 can all be enough to trigger symptoms in some people.”
Lifestyle and environmental factors can also trigger migraine, including dehydration, skipping meals, caffeine and abrupt temperature changes1,19, such as moving from a warm environment into an air-conditioned room.
Frequent use of pain-relieving medicines over time may contribute to medication overuse headache20 in some people.
Research has helped doctors better understand what happens in the brain during a migraine attack. One area involved is the hypothalamus, which helps regulate functions such as sleep, appetite and hormones3.
Prof Ong explains: “Researchers have identified CGRP, or calcitonin gene-related peptide, as one of the key molecules involved in migraine4. Newer treatments either target CGRP or block its receptor4, helping to interrupt a pathway involved in migraine⁴.”
Because these therapies are more targeted, he says, they are designed to minimise effects on other pathways, which may improve tolerability and safety4.
He says: “Migraine treatment is no longer a one-size-fits-all approach. Advances in treatment, including newer targeted therapies, have expanded the options available4, allowing doctors to tailor care to individual patients4.”
Nevertheless, treatments – both pharmacological and lifestyle modifications – should be tailored to each patient4. “Even the best treatment must be tailored to a patient’s lifestyle and occupation to be effective,” says Prof Ong.
Learn more about migraine, including its symptoms, triggers and when to seek medical advice.
Footnotes:
1. Mayo Clinic Staff, “Migraine: Symptoms and Causes,” Mayo Clinic, last updated July 8, 2025, accessed July 2, 2026.
2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition: 1.1 Migraine without aura. Cephalalgia. 2018;38(1):1–211
3. Goadsby PJ, Lipton RB, Ferrari MD. “Migraine – Current Understanding and Treatment.” N Engl J Med. 2002;346(4):257–270.
4. Ailani J, Burch RC, Robbins MS, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice.
5. Duke-NUS Medical School: Migraine is a billion-dollar headache for Singapore, nationwide study finds. Published September 18, 2019. Accessed July 2, 2026.
6. American Migraine Foundation. Migraine in Women. American Migraine Foundation. Accessed July 2, 2026.
7. Jonathan Jia Yuan Ong, Devanshi Patnaik, Yee Cheun Chan, Oliver Simon, and Eric A. Finkelstein, “Economic Burden of Migraine in Singapore,” Cephalalgia Reports 3 (2020)
8. Khu JV, Siow HC, Ho KH et. al. Headache diagnosis, management and morbidity in the Singapore primary care setting: findings from a general practice survey Singapore Med J 2008;49(10):744.
9. Migraine & Headache Australia, “Migraine Awareness Month,” accessed July 2, 2026
10. Katsarava Z, Buse DC, Manack AN, Lipton RB. Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep 2012; 16 (1): 86–92.
11. Richard B. Lipton, Dawn C. Buse, et al., “Migraine Progression: A Systematic Review,” Headache 55, no. 1 (2015): 4–24.
12. Migraine Acute and Preventive Treatment: A Practical Guide to Modern Therapy, Medaptly.
13. Blumenfeld AM. Clinician-Patient Dialogue About Preventive Chronic Migraine Treatment. J Prim Care Community Health. 2020;11:2150132720959935. doi:10.1177/2150132720959935.
14. World Health Organization, “Headache Disorders,” accessed July 2, 2026.
15. NICE. Headaches in over 12s: diagnosis and management (CG150), 19 September 2012, National Institute for Healthcare Excellence.
16. American Migraine Foundation. Top 10 Migraine Triggers and How to Deal with Them. American Migraine Foundation. July 27, 2017. Accessed September 4, 2026.
17. American Migraine Foundation. Migraine “Let Down” Headache. American Migraine Foundation. September 1, 2022. Accessed September 4, 2026.
18. Al‑Quliti et al., Behav Sci (Basel). 2022 Mar 1;12(3):65. doi: 10.3390/bs12030065 https://pmc.ncbi.nlm.nih.gov/articles/PMC8945022/
19. Legesse et al., BMC Nutrition (2025) 11:60 https://doi.org/10.1186/s40795-025-01048-8
20. Cleveland Clinic, “Rebound Headaches: What They Are, Symptoms & Treatment,” last updated August 2, 2023, accessed July 2, 2026
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