Handling Migraine during Pandemic Times

COVID pandemic has bought troubles to various segments of people suffering with different chronic diseases. The situation got complicated due to similarities in symptoms of these diseases and COVID. One such disease where in patients are facing lot of dilemma and are forced to undergo unnecessary trauma is Migraine. Migraine is one that causes severe headache in its patients and this is said to be same in COVID also. Then the question is how to go about it and to distinguish both and provide proper treatment to these patients. Here are some facts that explains Migraine…

What is Miagraine?

Migraine is a chronic neurological disorder which is the 6th commonest and 2nd most disabling medical condition in the world. Worldwide, the 1-year period prevalence of migraine is 14.7%. However, Indians have more migraines than the rest of the world. at least one in four persons in India suffers from migraines. Even with a conservative estimate, at least 25% of these patients visit the physicians or hospitals periodically for the treatment of their migraine. Further, 2–4% of emergency department (ED) visits occur due to non-traumatic headaches and out of that, about 35% of the visits occur due to migraines.

How can we minimize face-to-face visits by migraine patients to the clinic and hospital?

Telemedicine should be practiced to minimize direct face-to-face visits. There shall be three groups of patients suffering from migraines. First will be those with diagnosed migraines which are infrequent. They need reassurance and minimal intervention. The second group of migraine patients will be those with frequent migraines with headache frequency falling in episodic range (4–14 headache days/month) and those with chronic migraine (>15 headache days/month). Both these groups shall need regular periodic consultations and optimization of their therapy, which in present condition can be done by video consultations.

How to manage patients presenting with new-onset headaches?

Headache disorders are primarily diagnosed by clinical history and only in a small proportion of patients additional investigations are required to rule out the secondary cause. Telemedicine can play a big role in the diagnosis and management of headache disorder.

When to worry about headaches?

Red flags of headache: Headache- severe, sudden onset, worst headache of life, any change in character of headache, worsening in change of posture, cough, straining, early morning headaches or headache which awakens from sleep. Headache associated with fever, weight loss, neck pain, confusion, altered sensorium, visual disturbances. Headache onset age after 50 yrs

Can headache be a symptom of Covid -19 infection?

Headache has been described as one of the symptoms of COVID-19 infection. Although uncommon it has been seen in approximately 8% of patients with COVID-19 infection. Further, some gastrointestinal symptoms such as nausea, vomiting reported in COID-19 infection can mimic the symptoms of migraine. Therefore, any new-onset severe headache or worsening of existing headache in terms of frequency and severity or change in the character of existing headache under current circumstances must raise suspicion of COVID-19 infection. These patients must be asked about their exposure risk and should be assessed in detail for co-existing symptoms such as fever, dry cough, fatigue, sputum production, shortness of breath, muscle and joint pains, sore throat, chills, nausea and vomiting, nasal congestion, and diarrhoea that have been associated with COVID-19 infection.

Is migraine headaches increasing with the current lockdown and change in lifestyle

Headaches are greatly influenced by the stressors. The current lockdown in India has changed the lifestyle. The psychological, emotional and financial stressors have increased in everyone with the current scenario due to loss of jobs, cut down of salaries. There is also increased screen time for both adults and children due to online classes, which also caused decreased sleep and increased frequency of headaches. Anxiety, depression has increased to great extent in the population which would contribute to migraine.

How to manage patients with current lifestyle

Try to avoid stressors; Daily exercise at home; to reduce screen time, especially after 10pm in the night. Please follow doctor's advice with telemedicine.

By understanding the above, we should able to distinguish the difference between both and provide solace to those suffering with the disease during the times of COVID pandemic.

- Dr. Sindhu Vasireddy, Neurologist, Aster Prime Hospital