During the unprecedented COVID-19 pandemic in 2020, the whole world faced an unusual health emergency. Medical care of chronic neurological diseases, such as Epilepsy, is being neglected. In this survey, we aimed to evaluate the impact of the COVID-19 pandemic on the care of people with Epilepsy (PwE) and to identify their risk factors for seizure worsening to direct better future medical care. We administered a web-based survey (submitted on August 5, 2020). It included socio-demographic, Epilepsy-related, and psychometric data (The Depression, Anxiety, and Stress Scale—21 Items(DASS21) and The Pittsburgh Sleep Quality Index (PSQI). Regression analysis identified predictors of seizure worsening. We collected responses from an online survey of PwE during the pandemic. Out of 151 responders, 71 patients complained of issues related to Epilepsy management and all of whom reached the treating physician and solved their problems. Sleep quality was compromised in 84 patients (55.6%). Two-thirds of the patients in our cohort (66.2%) reported depression, 72.2% reported anxiety, and 75.5% reported stress. Eight patients (5.3%) got COVID-19 infection, and only one patient suffered from mild worsening of the seizure. The main concerns were shortage of medications for 46 (30.5%) patients, getting Coronavirus infection for 67 (44.4%) patients, and seizure worsening for 32 (21.3%) patients. Thirty-five patients (23.2%) reported seizure worsening, which was best explained by retirement or jobless state, having moderate or severe stress, poor sleep quality, vagus nerve stimulation (VNS), fear of getting COVID-19 infection, fear of worsening of seizures, or shortage of medication. During the current COVID-19 pandemic, a significant percentage of PwE experienced worsening of their seizures. This unusual, challenging experience clarifies the urgent need to establish telemedicine services and home-based management of Epilepsy, including ambulatory EEG, home video, and medication delivery to patients’ homes to provide continuous medical care.

Background Coronavirus disease-19 is caused by the severe acute respiratory syndrome coronavirus 2 Headache is a common symptom during and after Coronavirus disease-19. We aimed to study headache character in relation to COVID-19. Methods This was a cross-sectional study. Patients who had Coronavirus disease-19, confirmed by reverse transcription polymerase chain reaction technique and presented to the headache clinic within 3 months after the onset of infections were identified to the study. Study included patients diagnosed as primary headache disorders according to The International Classification of Headache Disorders, 3rd edition. Participants were grouped into categories according to having previous or de novo headache. Descriptive data, paired sample t-test and the chi-squared test (X2) were used for statistical analyses of the data. Results A total of 121 patients were included in this study. Their mean age was 35.29 + 9.54 and most of them were females (83.5%). Prior to Coronavirus disease-19 infections, 78 (64.5%) had migraine and 11(9.1%) experienced a tension-type headache while 32 (26.4) reported de novo headache post Coronavirus disease-19. Patient had significant increase in headache days 11.09 ± 8.45 post Coronavirus disease-19 compared with 8.66 ± 7.49 headache days before Coronavirus disease-19 infection (p < 0.006). Post Coronavirus disease-19, the usage of analgesic increased significantly by the patient with migraine (2.31 ± 1.65 vs 3.05 ± 2.09, p = 0.002) while the patient with tension type headache had statistically significant increase in severity (5.556 ± 1.86 vs 7 ± 2.25, p = 0.033) and frequency (7 ± 6.29 vs 12.72 ± 7.96, p = 0.006) of headache attacks. Bi-frontal and temporal headache are the most reported (40.6% each) headache site among de novo headache group. Patients younger than 40 years had longer duration of the headache attack (18.50 ± 16.44 vs 5.5 ± 9.07, p = 0.045) post COVID-19. Male patients compared to females (8.66 ± 1.15 versus 5.93 ± 2.01 p = 0.04) had more severe headache post Coronavirus disease-19. De novo headache resolved within 1 month in most of patients (65.3%). Conclusion Primary headache get worse after Coronavirus disease-19. De novo primary headache is frequent post Coronavirus disease-19 and resolve within 1 month. Headaches related to Coronavirus disease-19 are severe, present as migraine phenotype. Young male patients with Coronavirus disease-19 tend to have worse headache.

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Background: Lock down caused sudden lifestyle changes and represented a massive impact on human health. We aimed to report new migraine headache precipitating factors due to lifestyle changes during coronavirus disease 2019 (COVID-19) Pandemic lockdown. Methods: This cross-sectional survey included patients diagnosed with migraine based on The International Classification of Headache Disorders, 3rd edition (ICDH-3). During the lockdown, we submitted an online self-reported web-based questionnaire to patients already diagnosed with migraine and attending headache clinic at Ibn Sian Hospital in Kuwait. Questions explored different new precipitating factors of migraine headache attacks during COVID-19 pandemic lockdown compared to precipitating factors before lockdown. Results: A total of 340 migraine patients responded to online questionnaire. The mean age of them is 34.65 years. Females were predominant 79.1%. Majority of the cohort 85 % has more than one trigger of migraine headache attack. During pandemic, the common precipitating factors were smell of strong odors in 214 (62.9%), followed by certain food  in 175 (51.8%), sleep disturbance in 120 (35.3%), emotional or mental stress  in 80 (23.6%), caffeine in 80 (23.6%), flickers of light in 78 (22.9%), weather changes in 68(20%), smoking in 65 (19.12%), noise in 56 (16.5%),  sun light exposure in 41 (12.1%), fasting/ hypoglycemia in 40 (11.7%), hormonal changes in 37 (10.6%), physical excretion/fatigue in 24 (7.1%), screen exposure in 20 (5.9%), and dehydration in 14 (4.1%) patients. Before pandemic, noises 200 (58.8%), flicker of light 180 (52.9%), weather changes 175 (51.5%), sun light 170 (50%), food 160 (48.5%) and 130 (38.2%) sleep deprivation were the most common precipitating factors of migraine. 40% did not report precipitating factors for migraine before lockdown. Conclusions: Change of habits during lock down exposed migraine patients to different precipitating factors. Strong odors, food, sleep disturbance and stress were the most common migraine headache precipitating factors during COVID-19 lockdown.

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