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Keeping migraine in mind

The virus pandemic is shaking up patterns of care, with some shifting on-line, but we must remain ready to meet the needs of people who experience migraine.

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 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References

1. americanmigrainefoundation.org/resource-library/migraine-treatment-during-covid-19/

2. Marmura MJ. Curr Pain Headache Rep 2018;22:81.

3. Wang C, et al. Int J Environ Res and Public Health 2020;17:729

4. apa.org/topics/stress-tips

5. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Lancet 2016;388:1545-602

6. Leonardi M, Raggi A. J Headache and Pain 2019;20:41

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