Migraine and Headache Treatment in Patong, Phuket: Acute and Preventive Care, IV Drip 24/7
Walk-in migraine and headache care in central Patong. Oral triptans, a fast IV migraine drip for severe attacks, and structured preventive plans for chronic and menstrual migraine. We screen for red-flag headache and refer for imaging when needed. Clinically reviewed by the Doctor Patong Takecare Clinic medical team.
WhatsApp now, get migraine help | Call +66 81 718 9080 | Find the clinic on Google Maps
Severe headache is one of the most common reasons travellers and residents walk into our Patong clinic. Heat, dehydration, jet lag, broken sleep, sun glare and a few drinks at dinner combine to trigger attacks in people who already live with migraine, and tension-type pain builds quietly through long days on a laptop or a scooter. Our job is to treat the attack quickly with the right drug class, separate ordinary primary headache from dangerous secondary causes, and put a prevention plan in place if attacks keep returning.
The three primary headaches and how they differ
Doctors use the ICHD-3 classification to sort recurrent headaches into three main primary types: tension-type, migraine and cluster. Tension-type headache is the most common, feels like a tight band across both sides of the head, is mild to moderate, and is not made worse by routine activity. Migraine is typically one-sided, throbbing, moderate to severe, made worse by movement, and comes with nausea and sensitivity to light and sound; about one in three people experience an aura beforehand (visual zig-zags, sensory tingling, brief speech change) that lasts five to sixty minutes. Cluster headache is much less common but unmistakable: severe one-sided pain behind or around the eye, with a watering eye, a runny or blocked nostril and a drooping eyelid on the same side, in bouts that recur at the same time of day. The treatment ladder is different for each, which is why the diagnosis matters before any prescription is written.
| Type | Typical features | Acute treatment | Prevention |
|---|---|---|---|
| Tension-type | Bilateral, band-like, mild to moderate, no nausea, no aura. Often linked to posture, stress and screen time. | Paracetamol 1g or ibuprofen 400 to 600mg. Avoid daily combination analgesics. | Address posture, sleep, hydration and stress. Amitriptyline 10 to 25mg at night if chronic. |
| Migraine | Often one-sided, throbbing, moderate to severe, 4 to 72 hours, with nausea, photophobia and phonophobia, with or without aura. | NSAID first; triptan if moderate to severe (sumatriptan, eletriptan, rizatriptan). Add antiemetic. IV drip for severe attacks. | Propranolol, topiramate, amitriptyline, candesartan, or CGRP monoclonal antibody. Botox for chronic migraine. |
| Cluster | Severe one-sided pain around the eye, lasting 15 to 180 minutes, with watering eye, blocked nose, drooping eyelid. Strict periodicity. Men more than women. | High-flow oxygen 12 to 15 L/min via non-rebreather for 15 minutes, or subcutaneous sumatriptan 6mg. | Verapamil 240 to 360mg/day, short steroid taper at bout onset, occipital nerve block. |
Acute migraine treatment, step by step
For a mild or moderate migraine attack, a non-steroidal anti-inflammatory taken at the very first sign works well: ibuprofen 600 to 800mg, naproxen 500mg or diclofenac 50mg, with paracetamol 1g as an alternative. For moderate to severe attacks, a triptan is first-line. Triptans are selective serotonin (5-HT1B/1D) agonists that reverse the painful dilation of intracranial vessels and quieten pain pathways in the brainstem; oral sumatriptan 50 to 100mg, eletriptan 40 to 80mg or rizatriptan 10mg work for most people, frovatriptan 2.5mg has a long half-life useful for menstrual attacks, and subcutaneous sumatriptan 6mg gives the fastest onset for very severe attacks or vomiting. Combining an NSAID with a triptan is more effective than either alone, and adding metoclopramide 10mg, prochlorperazine 10mg or ondansetron 4 to 8mg both treats nausea and improves gastric emptying so the tablets actually absorb. The newer gepants (rimegepant, ubrogepant, atogepant, zavegepant nasal spray) block the CGRP receptor and are useful when triptans fail or are contraindicated. Lasmiditan, a 5-HT1F agonist, is another non-vasoconstricting option. We deliberately avoid opioids (codeine, tramadol, morphine) and butalbital combinations: they worsen long-term outcomes, carry addiction risk and drive medication-overuse headache.
The IV migraine drip for severe attacks
If oral treatment has failed at home, or if you are vomiting and cannot keep tablets down, the in-clinic IV migraine drip usually breaks the attack within an hour. Our standard protocol is intravenous fluids (500 to 1000mL of normal saline) with magnesium sulfate 1g, metoclopramide 10mg, ketorolac 30mg and ondansetron 8mg, and we add dexamethasone 8mg at the end to reduce the risk of recurrence over the following 24 to 72 hours. You rest in a quiet, dimly lit cubicle for the duration, typically 60 to 90 minutes. The combination targets several migraine pathways at once: rehydration, magnesium for cortical excitability, metoclopramide for dopaminergic nausea and pain, ketorolac for the inflammatory component, ondansetron for serotonergic nausea, and steroid for delayed recurrence. Most people leave the clinic able to sleep it off. Triptans are not used inside this drip if you have already taken one at home; we space them at least 24 hours apart. For pregnant patients and anyone with cardiovascular contraindications, we adapt the protocol (no triptans, ketorolac avoided in late pregnancy, paracetamol-based instead).
Triptan safety and who should not take them
Triptans are well tolerated by most people but mildly constrict blood vessels, so they are not safe in everyone. We do not prescribe them in known coronary artery disease, after a heart attack or stroke, in uncontrolled high blood pressure, in hemiplegic or basilar migraine, in pregnancy as a general rule, or alongside a monoamine oxidase inhibitor taken in the last two weeks. Common side effects, called “triptan sensations”, include warmth, tingling, mild chest or jaw tightness and brief fatigue; these are not dangerous in people without cardiac risk but can feel alarming the first time. If you have multiple cardiovascular risk factors (age over 50, hypertension, diabetes, smoking, family history of early heart disease), we screen first and use a gepant or lasmiditan instead. A CGRP receptor antagonist does not constrict vessels and is the safer choice in that situation.
Preventive treatment for frequent or disabling migraine
We offer preventive treatment if you have four or more headache days per month, two or more disabling days, or attacks that consistently fail acute treatment. The aim is to roughly halve attack frequency and severity over three months. First-line oral options are propranolol 80 to 240mg per day, a beta-blocker that is cheap, well-studied and helpful where anxiety coexists; topiramate 50 to 100mg per day, with side effects of paresthesia, mild cognitive slowing and modest weight loss; amitriptyline 10 to 50mg at night, especially where insomnia or tension-type headache coexists; and candesartan 16mg per day, an angiotensin receptor blocker with strong trial evidence. Venlafaxine and valproate are second-line options. For chronic migraine (15 or more headache days per month for three months), onabotulinum toxin A (Botox) given as 31 small injections every 12 weeks is licensed and effective, and we coordinate this with a specialist. Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) given monthly or quarterly are the newest class, very well tolerated and now first-line in many countries; we can prescribe these or arrange referral. Prevention is reviewed at three months and continued for six to twelve months before considering a slow taper.
Triggers, trigger diary and medication overuse
Most migraineurs have several personal triggers rather than one. Common ones are emotional stress (and paradoxically the “let-down” after stress), hormonal change around menstruation, sleep deprivation or oversleeping, missed meals, dehydration, bright sunlight or flickering screens, loud noise, strong smells, tyramine-rich foods (aged cheese, cured meat with nitrates, MSG), chocolate, alcohol (especially red wine) and weather change. A simple two-month trigger diary, recording the date, intensity, suspected trigger and treatment, is usually more revealing than guessing. Medication-overuse headache is a separate, important problem: using acute treatment on more than 10 to 15 days per month for three months turns the original headache into a daily one. The treatment is to stop the overused medication (gradually for opioids and barbiturates), bridge with a short steroid or naproxen course, and start prevention at the same time. Most people recover their original headache pattern within two months.
When to see a doctor
Most headaches are primary and not dangerous, but a small number signal something serious. The SNOOP red flags from the American Headache Society capture the main warning patterns. Systemic features (fever, weight loss, immunosuppression, known cancer), neurological signs (focal weakness, altered consciousness, papilloedema), new onset over age 50, sudden “thunderclap” onset reaching peak intensity in seconds, a clear change from your previous headache pattern, headache that is positional or triggered by Valsalva, and any new headache in pregnancy all need urgent assessment. A thunderclap headache is treated as subarachnoid haemorrhage until proven otherwise, head trauma with severe headache needs imaging, and fever with neck stiffness needs meningitis workup. We make these calls quickly and refer to Bangkok Hospital Phuket or BPK Hospital for CT or lumbar puncture if any red flag is present.
Sudden “thunderclap” headache reaching peak severity in seconds (possible subarachnoid haemorrhage). New focal weakness, numbness, slurred speech or vision loss with headache (possible stroke). Fever with neck stiffness, photophobia or confusion (possible meningitis or encephalitis). Recent head injury followed by worsening headache or vomiting. First-ever severe headache after age 50, especially with scalp tenderness or jaw claudication (possible giant cell arteritis). New severe headache in pregnancy or the first six weeks after delivery (possible pre-eclampsia or cerebral venous thrombosis). A clear change from your usual headache pattern in someone with HIV or cancer. Call +66 81 718 9080 or go directly to Bangkok Hospital Phuket.
You are having an attack now and oral medication has not worked, you are getting four or more headache days per month, your attacks disrupt work or family life, you are using acute painkillers more than two days per week, you suspect medication-overuse headache, you want to start or review preventive treatment, or you have any of the SNOOP red flag features above. WhatsApp +66 95 073 5550 for same-day assessment and, if needed, an IV migraine drip.
Prevention and early self-care
Lifestyle measures genuinely reduce migraine frequency when applied consistently. A regular sleep schedule with the same wake time on weekends matters more than total hours; both undersleeping and oversleeping trigger attacks. Steady hydration in Phuket heat (around 2 to 3 litres per day if you are active) and not skipping meals address two of the most common trigger pairs. Caffeine in moderation can help, but more than 200mg per day risks withdrawal headache on travel days. Three supplements have reasonable evidence for prevention and a low side-effect profile: riboflavin (vitamin B2) 400mg per day, magnesium 400 to 600mg per day, and coenzyme Q10 100mg three times per day. Aerobic exercise, biofeedback, cognitive behavioural therapy and acupuncture all show modest benefit in trials. Treating an attack early, within the first 30 minutes and before nausea sets in, makes oral medication far more likely to work.
Summary
Tension-type headache, migraine and cluster headache need different drugs, and the diagnosis comes first. For acute migraine in Patong we offer oral triptans with an antiemetic, a combined NSAID-triptan strategy where appropriate, and an IV migraine drip with magnesium, metoclopramide, ketorolac, ondansetron and dexamethasone for severe or vomiting attacks. We avoid opioids and butalbital. Prevention with propranolol, topiramate, amitriptyline, candesartan or a CGRP monoclonal antibody is offered when attacks reach four or more days per month or disrupt work. We screen for SNOOP red flags at every visit and refer to Bangkok Hospital Phuket for imaging when any are present.
“The two mistakes we see most often in migraine are taking the wrong drug class (paracetamol again, then opioids) and waiting until vomiting has already started. The right triptan, taken in the first 30 minutes, ends most attacks. For the rest, an IV drip in a quiet cubicle usually does the job within the hour.”
Doctor Patong Takecare Clinic medical team
Frequently asked questions
How do I tell a tension headache from a migraine?
Tension-type headache feels like a tight band across both sides of the head, is mild to moderate, and does not stop you walking around or working. Migraine is usually one-sided, throbbing, moderate to severe, made worse by routine movement, and comes with nausea and sensitivity to light and sound; many people need to lie down in a dark room. A simple rule used in research is that two of the following point to migraine: pulsating pain, one-sided, moderate to severe intensity, and worse with activity, together with either nausea or photophobia plus phonophobia. If you are unsure, treat as migraine, because the consequences of under-treating migraine are larger than the consequences of over-treating tension-type headache.
What is in the IV migraine drip and how fast does it work?
Our standard drip is 500 to 1000mL of normal saline with magnesium sulfate 1g, metoclopramide 10mg, ketorolac 30mg, ondansetron 8mg and dexamethasone 8mg added at the end. It runs over 60 to 90 minutes in a quiet, low-light cubicle. Most people notice the pain easing within 30 to 45 minutes and the nausea sooner. The dexamethasone is included specifically to reduce the chance of the headache rebounding over the next 24 to 72 hours. We adapt the protocol in pregnancy, in known cardiac disease and in patients who have already taken a triptan at home that day.
Why do you avoid opioids and tramadol for migraine?
Opioids (codeine, tramadol, morphine) and butalbital combinations do reduce pain in the short term, but the evidence is clear that they worsen migraine over months and years. They make people more sensitive to future attacks, accelerate progression to chronic migraine, drive medication-overuse headache, and carry real addiction risk. Triptans, NSAIDs, antiemetics, gepants and the IV drip protocol are all more effective and safer for migraine specifically. The only exception is the occasional rescue dose in pregnancy where almost every other option is contraindicated, and even then we prefer paracetamol-based protocols first.
Are triptans safe? I have heard about heart risks.
Triptans are safe for the large majority of people with migraine. They mildly constrict blood vessels, so they are not used in known coronary disease, after a heart attack or stroke, in uncontrolled hypertension, in hemiplegic or basilar migraine, in pregnancy as a rule, or with a monoamine oxidase inhibitor taken in the last two weeks. Common “triptan sensations” of warmth, tingling and brief chest or jaw tightness are uncomfortable but not dangerous in people without cardiac risk. If you have multiple cardiovascular risk factors, we screen first and prescribe a CGRP receptor antagonist (rimegepant, ubrogepant) or lasmiditan instead, neither of which constricts vessels.
When should I start preventive treatment?
The thresholds we use are four or more headache days per month, two or more disabling days, attacks that consistently fail acute treatment, or any use of acute medication on more than two days per week. Prevention is also offered earlier if a particular form of migraine has a high disability profile, for example hemiplegic migraine, prolonged aura or status migrainosus. Propranolol, topiramate, amitriptyline and candesartan are first-line oral options; CGRP monoclonal antibodies are increasingly used as first-line where available; Botox is reserved for chronic migraine (15 or more headache days per month). We review effect at three months and continue for six to twelve months before any taper.
What can I take for migraine in pregnancy?
Paracetamol 1g is the safest first-line acute treatment in pregnancy. Metoclopramide 10mg is acceptable for nausea and modestly helps the headache. NSAIDs (ibuprofen, naproxen, diclofenac) are reasonable in the second trimester but avoided in the first and third. Triptans, gepants and ergots are generally avoided unless the benefit clearly outweighs the risk; sumatriptan has the most pregnancy safety data and is sometimes used in the second trimester under specialist advice. For prevention in pregnancy, propranolol and amitriptyline have the longest safety record; topiramate and valproate are avoided. A new severe headache in pregnancy, especially with high blood pressure, visual change or swelling, is treated as pre-eclampsia or cerebral venous thrombosis and goes straight to hospital.
Sources
American Headache Society. Consensus statement: The American Headache Society position statement on integrating new migraine treatments into clinical practice. americanheadachesociety.org/resources/professional.
National Institute for Health and Care Excellence. CG150 Headaches in over 12s: diagnosis and management. nice.org.uk/guidance/cg150.
International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). ichd-3.org.
Book migraine treatment now
WhatsApp: start now
Call +66 81 718 9080 to speak to a doctor
Find Doctor Patong Takecare Clinic on Google Maps
Migraine, migraine with aura, migraine without aura, tension-type headache, cluster headache, chronic migraine, episodic migraine, menstrual migraine, hemiplegic migraine, basilar migraine, status migrainosus, medication-overuse headache, ICHD-3, SNOOP red flags, thunderclap headache, subarachnoid haemorrhage, giant cell arteritis, sumatriptan, eletriptan, rizatriptan, frovatriptan, naratriptan, zolmitriptan, almotriptan, rimegepant, ubrogepant, atogepant, zavegepant, lasmiditan, ditans, gepants, CGRP, CGRP monoclonal antibody, erenumab, fremanezumab, galcanezumab, eptinezumab, onabotulinum toxin A, Botox, propranolol, topiramate, amitriptyline, candesartan, venlafaxine, valproate, ibuprofen, naproxen, diclofenac, ketorolac, paracetamol, metoclopramide, prochlorperazine, ondansetron, magnesium sulfate, dexamethasone, riboflavin, coenzyme Q10, IV migraine drip, occipital nerve block, verapamil, high-flow oxygen, Bangkok Hospital Phuket, BPK Hospital, Patong, Kalim, Kamala, Karon, Phuket, Doctor Patong Takecare Clinic.