Evaluation of the Impact of the COVID-19 Lockdown in the Clinical Course of Migraine

Abstract

Objective Previous studies have demonstrated that emotional stress, changes in lifestyle habits and infections can worsen the clinical course of migraine. We hypothesize that changes in habits and medical care during coronavirus disease 2019 (COVID-19) lockdown might have worsened the clinical course of migraine. Design Retrospective survey study collecting online responses from migraine patients followed-up by neurologists at three tertiary hospitals between June and July 2020. Methods We used a web-based survey that included demographic data, clinical variables related with any headache (frequency) and migraine (subjective worsening, frequency, and intensity), lockdown, and symptoms of post-traumatic stress. Results The response rate of the survey was 239/324 (73.8%). The final analysis included 222 subjects. Among them, 201/222 (90.5%) were women, aged 42.5 ± 12.0 (mean±SD). Subjective improvement of migraine during lockdown was reported in 31/222 participants (14.0%), while worsening in 105/222 (47.3%) and was associated with changes in migraine triggers such as stress related to going outdoors and intake of specific foods or drinks. Intensity of attacks increased in 67/222 patients (30.2%), and it was associated with the subjective worsening, female sex, recent insomnia, and use of acute medication during a headache. An increase in monthly days with any headache was observed in 105/222 patients (47.3%) and was related to symptoms of post-traumatic stress, older age and living with five or more people. Conclusions Approximately half the migraine patients reported worsening of their usual pain during the lockdown. Worse clinical course in migraine patients was related to changes in triggers and the emotional impact of the lockdown.

Social Distancing in Chronic Migraine during the COVID-19 Outbreak: Results from a Multicenter Observational Study

“…Finally, social distancing has surprisingly shown a global positive effect on migraine patients. This result is in line with several recent studies [12,[68][69][70][71][72]. Our data show that the patients' occupational status was not associated with the course of migraine during social distancing (Table 1).…”

“…We found an association between a decrease in sleep quality and migraine worsening, in line with previous literature [12,71]. Our finding suggests that decreased sleep quality contributed to migraine worsening during social distancing.…”

Experiment in vivo: How COVID-19 Lifestyle Modifications Affect Migraine

“…Long-lasting insecurity and stress related to the pandemic could potentially have led to an increased migraine disability (14). In contrast with the evidence presented in the previous section, a Spanish study found out that the overall long-term effects of COVID-19 lockdowns on migraine are negative (9). Approximately half of the studied patients shared a negative lockdown-related impact on their headache (9).…”

Indomethacin for refractory COVID or post-COVID headache: a retrospective study

“…COVID patients may have or not migraine as a comorbidity [ 1 ]. In addition, headache may occur during or after COVID with no clear relationship with migraine mechanisms [ 1 , 13 , 14 ]. However, some patients with migraine and COVID may seek help in general practitioners or emergency departments and receive unspecific prescriptions for the headache itself.…”

“…However, some patients with migraine and COVID may seek help in general practitioners or emergency departments and receive unspecific prescriptions for the headache itself. Others will try using their usual acute migraine medications seeking to alleviate the head pain [ 13 – 16 ].This retrospective study aimed at describing the outcomes of indomethacin use in patients, with or without migraine, who presented headache not responding to their acute medication during COVID acute phase or after > 10 days of confirmed infection by SARS-CoV-2.…”