The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study

Abstract

Background Coronavirus disease 2019 (COVID-19) bring about a range of psychological distress and symptom deterioration to headache patients especially to some migraineurs. Compared to migraineurs or normal control, medication overuse headache (MOH) patients are more likely to experience a worse psychological distress and poorer outcome in non-COVID-19 time. However, in COVID-19 pandemic, whether MOH patients would have greater physical and mental symptom deterioration or worse relief of headache symptoms and medications overuse remained unclear. We aim to investigate the impact of COVID-19 on MOH patients to guide for a better management in this study. Methods We enrolled MOH patients who were diagnosed and treated at headache clinic of West China Hospital. Information of the pre-pandemic 3 months period and COVID-19 pandemic period was collected. Univariate and multivariate logistic regression were performed to identify independent factors associated with changes in headache symptoms and drug withdrawal. Results Seventy-eight MOH patients were enrolled into the study ultimately. In comparison to pre-pandemic period, fewer MOH patients reported decreased headache days, intensity and days with acute medications per month during the pandemic. Available access to regular prophylactic medications was significantly associated with a reduction of at least 50% in headache days and decrease in headache intensity per month with respective odds ratios of 39.19 (95% CI 3.75–409.15, P = 0.002) and 10.13 (95% CI 2.33–44.12, P = 0.002). Following abrupt withdrawal and high educational level were both significant factors in decreasing headache intensity. Male sex was significantly associated with decrease in days with acute medication per month during the pandemic (odds ratios 4.78, 95%CI 1.44–15.87, P = 0.011). Conclusions Our findings reflect that MOH patients experienced a worse relief of headache symptoms and drug withdrawal during the pandemic. Available access to regular prophylactic medications was the significant independent factor for improvement of headache symptoms. Male sex was significantly associated with decreased days with acute medications per month.

Headaches associated with COVID-19

“…Негативное влияние пандемии COVID-19 в целом также было продемонстрировано у пациентов с чрезмерным потреблением симптоматических средств для купирования головной боли. Например, C. Li et al продемонстрировали, что у пациентов с лекарственно-индуцированной головной болью наблюдалось отчетливое ухудшение ее течения и утяжеление ведения пациентов в период отмены абузусных препаратов во время пандемии по сравнению с периодом до пандемии [29].…”

Telemedicine efficacy and satisfaction of patients and headache specialists in migraine management

“…Since the outbreak of COVID-19, strict transportation restrictions and quarantine policies in China have made cross-regional visits more difficult, and remote migraine patients’ access to care and follow-up is further limited. According to a study from the headache clinic of West China Hospital, during the pandemic, only 41.0% of patients with medication overuse headache (MOH) were able to receive regular prophylactic medications, while the majority of these patients used to receive regular prophylactic medications and approximately 50% of them experienced abrupt withdrawal ( Li et al, 2021 ).…”