New precipitating factors for migraine during Covid-19 pandemic lockdown

Abstract

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.

Migraine with aura: less control over pain and fragrances?

“…It has been shown that Covid-19 can induce temporary, or sometimes complete smell loss [ 81 ]. In addition, during lockdown, smells were precipitating factors of migraine attacks even more than before the pandemic [ 82 , 83 ], and higher post-infection olfactory symptoms were found in migraine Covid-19 survivors as compared to non-migraine survivors [ 84 ]. None of the patients included here had Covid-19, or had recovered from Covid-19 in the two weeks prior to testing.…”

Migraine in Covid-19 lockdown

“…They describe significant changes in how such factors would act before and after the Covid-19 pandemic. 26 Interestingly, the cultural relationship with one of the most cited migraine triggers -a strong or particular type of smell -was commented on during the lockdown. The reason that odors are indicated as the main trigger of migraine attacks is interpreted as increased consumption and exposure to incense smoke and the use of Arab perfumes by the population.…”