Managing migraine in the times of COVID-19 pandemic

Chowdhury, Debashish; Datta, Debabrata

doi:10.4103/aian.aian_296_20

Cited by 21 publications

(31 citation statements)

References 30 publications

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“…In the absence of therapeutic procedures, other preventive therapies such as self-injectable monoclonal antibodies, neuromodulation devices and oral corticosteroids could be tried. There is no evidence that the use of nonsteroidal anti-inflammatory drugs (NSAIDS) can worsen COVID-19 clinical course, thus it could be used appropriately [ 2 , 31 ]. However, we stress that paracetamol (acetaminophen) can be used as a first choice in headache treatment, given its safety and better tolerability [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study

2020

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Background Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the “real-world” impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome. Methods We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty in getting medications, medication overuse, symptoms of anxiety and/or depression, sleep and eating habits disturbance, screen time exposure, work during pandemic, use of traditional medicine, effect of Botox injection cancellation, and overall worries and concerns during pandemic. Results A total of 1018 patients completed the survey. Of the respondents, 859 (84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were married, and 466 (45.7%) reported working during the pandemic. In comparison to pre-pandemic period, 607 respondents (59.6%) reported increase in migraine frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed to chronic migraine. Severity was reported to increase by 653 (64.1%) respondents. The majority of respondents; 626 (61.5%) did not communicate with their neurologists, 477 (46.9%) reported compliance to treatment, and 597 (58.7%) reported overuse of analgesics. Botox injections cancellation had a negative impact on 150 respondents (66.1%) from those receiving it. Forty-one respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of their headaches amid infection period. Sleep disturbance was reported by 794 (78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety and/or depression. Conclusions and relevance COVID-19 pandemic had an overall negative impact on patients with migraine. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for patients with migraine, with emphasis on psychosocial well-being.

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Section: Discussionmentioning

confidence: 99%

“…Since then, health care systems around the world have been overwhelmed with this unprecedented public health crisis. Neurologists are facing a huge challenge in providing quality care to their patients with chronic diseases, in particular those with migraine, while working to minimize the spread of COVID-19 outbreak [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study

2020

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“…In our opinion, the pandemic, through the study of abruptly changing people’s lifestyle, may offer the unique opportunity to confirm or discover the role of different environmental factors in the migraine pathogenesis. Notwithstanding the relevant impact of the COVID-19 pandemic on general health, scientific task forces have provided recommendations for the care of migraine [ 36 , 37 ]. However, very little has been discussed about the fundamental role of PA and eating habits during the lockdown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: The restrictions taken to control the rapid spread of COVID-19 resulted in a sudden, unprecedented change in people’s lifestyle, leading to negative consequences on general health. This study aimed to estimate the impact of such changes on migraine severity during 2020 March–May lockdown. Methods: Patients affected by migraine with or without aura, diagnosed by expert physicians, completed a detailed interview comprehensive of: assessment of migraine characteristics; measure of physical activity (PA) levels; measure of the intake frequency of main Italian foods; the Insomnia Severity Index (ISI) questionnaire investigating sleep disorders. Results: We included 261 patients with a mean age of 44.5 ± 12.3 years. During social distancing, 72 patients (28%) reported a headache worsening, 86 (33%) an improvement, and 103 (39%) a stable headache frequency. A significant decrease of the PA levels during COVID-19 quarantine in the whole study sample was observed (median total metabolic equivalent task (METs) decreased from 1170 to 510; p < 0.001). Additionally, a significant difference was reported on median ISI scores (from 7 to 8; p < 0.001), which were increased in patients who presented a stable or worsening headache. Conclusions: Our study confirmed that the restrictions taken during the pandemic have affected the practice of PA levels and sleep quality in migraine. Hence, PA and sleep quality should be assessed to find strategies for an improvement in quality of life.

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“…When screening patients, it is important for physicians to be vigilant for red flags pointing to a secondary headache and refer these patients for face-to-face consultations. 7 These include new-onset severe headache, worsening of existing headache (frequency or severity), change in the character of an existing headache as well as presence of focal neurological abnormalities or constitutional symptoms.…”

Section: Patient Selection and Initial Classificationmentioning

confidence: 99%

“…Clinical tasks such as reviewing history, medications, treatment response and education are easily performed via telemedicine approaches. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Telemedicine Applications for the Evaluation of Patients with Non-Acute Headache: A Narrative Review

Noutsios¹,

Boisvert-Plante²,

Pérez³

et al. 2021

JPR

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The COVID-19 pandemic has spurred a hasty transition to virtual care but also an abundance of new literature highlighting telehealth’s capabilities and limitations for various healthcare applications. In this review, we aim to narrate the current state of the literature on telehealth applied to migraine care. First, telemedicine in the context of non-acute headache management has been shown to produce non-inferior patient outcomes when compared to traditional face-to-face appointments. The assignment of patients to telehealth appointments should be made after referring more urgent cases to dedicated in-person clinics. During the virtual appointment, physicians can ask their patients about the “3 F’s” in order to perform a thorough assessment of their headaches: frequency of headache days, frequency of acute medication usage and functional impairment. Clinical assessment scores that have been studied and deemed feasible for telemedicine, safe and efficient include the HIT-6, VAS and MIDAS scores. Although MIDAS was found to be redundant and inadequate to use on a daily basis, we suggest that it can be useful in periodic remote follow-up appointments. Additionally, several mobile health apps have been studied including Migraine Buddy, Migraine Coach and Migraine Monitor. All of these are appropriate for use in telemedicine when combined with an adequate trial period with Migraine Buddy being rated the highest, as it captures the most detailed clinical picture. High satisfaction rates have been reported for virtual headache management which were shown to be equal to in-person consults. These are based on patients’ perceived increase in convenience due to avoided travel time, less disruption of their daily routine and feeling more comfortable in the environment of their choice. Despite this, limitations such as technological knowledge, access to videoconferencing modalities and having a more impersonal consultation with the physician may hinder some patients from adopting this service.

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Managing migraine in the times of COVID-19 pandemic

Cited by 21 publications

References 30 publications

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study

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

Telemedicine Applications for the Evaluation of Patients with Non-Acute Headache: A Narrative Review

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