(English version for international readers)

by Dr Hsu-Huai, Chiu, MD, Neurologist

Migraines are more than “just headaches.” They are a neurological condition that can cause severe, throbbing pain, nausea, sensitivity to light or sound, and major disruption to daily life. Many people in Taiwan experience migraines, and effective treatments are available — including preventive medications, lifestyle adjustments, and in some cases Botox for chronic migraine.

This guide provides a clear overview for international patients living in Taiwan, based on the way neurologists typically evaluate and treat migraines here.

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What Is a Migraine?

A migraine is a recurrent neurological disorder characterized by moderate to severe headache, often on one side of the head, combined with symptoms such as:

• Nausea or vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Visual disturbances (aura)
• Neck stiffness
• Fatigue after the attack

Migraine attacks can last from 4 to 72 hours.

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Common Types of Migraine

1. Episodic Migraine

• Fewer than 15 headache days per month
• Most patients fall into this category
• Responds well to preventive medicine if attacks are frequent

2. Chronic Migraine

• 15 or more headache days per month
• At least 8 days per month meet migraine criteria
• May require Botox or combination preventive therapy

3. Migraine With Aura

• Reversible visual or sensory symptoms (e.g., flashing lights, zig-zag lines, numbness)
• Symptoms usually last 5–60 minutes
• Not a stroke, but evaluation is important if new or severe

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Common Migraine Triggers

• Stress or emotional tension
• Lack of sleep or irregular sleep schedule
• Hormonal changes
• Weather and air pressure changes
• Strong smells or bright lights
• Certain foods (caffeine changes, alcohol, MSG, aged cheese)
• Skipping meals
• Dehydration

Keeping a headache diary is extremely helpful for identifying patterns.

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Red Flags (When You Should Seek Urgent Care)

If you experience any of the following, visit an emergency department:

• Sudden, severe “thunderclap headache”
• Headache with fever or stiff neck
• Neurological symptoms lasting longer than 1 hour
• New headache after age 50
• Headache after head injury
• Progressive worsening over weeks
• Weakness, slurred speech, loss of balance

These symptoms may indicate a secondary cause (infection, stroke, bleeding, etc.) and must be evaluated urgently.

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How Migraines Are Diagnosed in Taiwan

Migraines are diagnosed clinically based on:

• Detailed headache history
• Frequency and duration
• Associated symptoms
• Triggers
• Response to past medications

Imaging (MRI or CT) is sometimes recommended when:

• Symptoms are atypical
• Red flags are present
• First severe episode occurs
• Neurological exam is abnormal

Most migraine cases do not require routine brain imaging.

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Treatment Options in Taiwan

Treatment usually includes acute medication + preventive strategies.

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1. Acute (Rescue) Medications

Used at the start of a migraine attack:

• Triptans (e.g., sumatriptan)
• NSAIDs (e.g., ibuprofen, naproxen)
• Acetaminophen
• Antiemetics for nausea (e.g., metoclopramide)

These help shorten or relieve attacks.

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2. Preventive Medications

Recommended if:

• Attacks occur ≥4 days per month, or
• Acute medications don’t work well, or
• Migraines significantly affect daily life

Common preventive options in Taiwan include:

• Beta-blockers (propranolol)
• Antidepressants (amitriptyline, venlafaxine)
• Antiepileptic drugs (topiramate, valproate)
• Calcium channel blockers
• Botox injections for chronic migraine

While Aimovig (erenumab) and other CGRP monoclonal antibodies are not widely available here, preventive therapy can still be highly effective with a proper plan.

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3. Lifestyle and Non-Medication Approaches

• Consistent sleep schedule
• Hydration and regular meals
• Stress reduction techniques
• Avoiding known triggers
• Exercise (aerobic activity helps reduce migraine frequency)

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What to Bring to Your First Neurology Appointment in Taiwan

• A headache diary (frequency, duration, triggers)
• List of medications used in the past (including Aimovig)
• Any MRI/CT scans done overseas
• Notes on which drugs worked or caused side effects

This helps your neurologist build an individualized treatment plan.

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When to Consider Botox (Chronic Migraine)

Botox is available in Taiwan for patients who meet:

• ≥15 headache days per month, and
• Headaches lasting for ≥3 months

It is performed every 12 weeks and is often effective for chronic cases.

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Living With Migraine in Taiwan

Migraines are common here, and neurologists are familiar with both local and international treatment guidelines.

With the right preventive strategy, many patients significantly reduce the frequency of attacks — even without access to CGRP monoclonal antibodies like Aimovig.

You don’t have to live with constant pain. Effective long-term plans do exist.