Keeping migraine in mind

Practical measures to maintain effective management of migraine while reducing the risk of COVID-19 spread have been suggested by The American Migraine Foundation.¹

In summary, they include:

• Urging people feeling unwell with cough, shortness of breath or fever to avoid clinic visits. Advice should be sought from primary healthcare providers.
• The postponement of non-emergency consultations for at least the next eight weeks
• Increased use of telemedicine as face-to-face consultations are replaced by telephone calls or secure videoconferencing. This is regarded as a safe alternative, for example, to many follow-up outpatient visits
• Reducing the need to visit pharmacies by ensuring that patients have several months’ supply of medication
• Limiting the need for emergency room visits by putting in place plans for rescue therapy when headache pain does not respond to usual first-line treatment.

For eligible patients, preventive treatment of migraine episodes could complement this approach.

Migraine affects more than 10% of the world’s population⁵

Managing stress in a time of anxiety

Migraines may be triggered by stress,² and COVID-19 is widely perceived as a cause of stress: in a national survey conducted in China in January 2020, 8% of respondents reported moderate to severe stress symptoms as a result of the pandemic.³ Hence stress-reduction techniques could work in reducing migraine frequency.

The American Psychological Association’s advice on managing stress includes these evidence-based suggestions:⁴ cultivate social support, relaxation, meditation, protecting healthy sleep, physical exercise, and re-framing thoughts through cognitive behavioral therapy.

While outdoor physical exercise is limited in a time of lockdown, there are routines that can be used at home; and social support no longer requires face-to-face contact.

A possible consequence of the much-needed concentration on emergency medical services is that migraine – already underdiagnosed and under-treated in relation to the extent of disability it causes⁵ – will fall further in the list of priorities.

In the 2015 Global Burden of Disease study, migraine was one of eight chronic diseases that each affected more than 10% of the world’s population.⁵

Given the impact of migraine on people’s lives, we must strive to ensure that the needs of people who experience this condition continue to be met.⁶