New insights from posters at IHC2021 on how COVID-19 tests and lockdowns have affected patients with migraine

Does a nasopharyngeal swab for COVID-19 trigger migraine?¹

A descriptive retrospective online survey of 309 healthcare professionals at University Hospital Marqués de Valdecilla, Spain, was carried out to determine whether nasopharyngeal swabs taken for COVID-19 polymerase chain reaction (PCR) tests trigger migraine attacks.

Over one-third of migraineurs had a migraine attack within 24 hours of their PCR test

The results were detailed in a poster presented by J Madera Fernández and colleagues.

Among the participants:

• 37% were migraineurs
• 47 (15%) reported a migraine attack within 24 hours of the PCR test — 37% of migraineurs and 3% of non-migraineurs (X²=66.6, p<0.00; odds ratio 22.6, 95% CI [8.6–59.4])

The characteristics of the post-PCR migraine attack including migraine aura were similar from those of previous migraine attacks.

The results suggest that purely peripheral trigeminal stimuli can induce migraine

The authors concluded that a nasopharyngeal swab taken for a COVID-19 PCR test could therefore induce a migraine attack in migraineurs, suggesting that purely peripheral trigeminal stimuli can induce migraine.

What has been the impact of COVID-19 lockdown on patients with migraine in Argentina?²

A descriptive, retrospective review of electronical medical records of patients attending a headache clinic in Argentina between May 26 and June 30, 2020, was carried out to evaluate the impact of the lockdown on patients with migraine.

During lockdown, 50% of Argentinian migraine patients experienced worsening frequency of headache

The results were detailed in a poster presented by María Vanesa Nagel and colleagues.

Of the 304 patients evaluated, 88% were female and mean age was 41 years.

Most of the patients (47%) had episodic migraine, 35% had chronic migraine, 9% had migraine with aura, and 9% had medication overuse headache.

During lockdown, 50% of patients experienced worsening frequency of headache, 29% remained stable, and 21% experienced improved frequency of headache.

• The main reasons for headache worsening were work (29%, with 70% of patients working from home), and mood changes (24%)
• The main reasons for headache improving were pharmacological preventive therapies (35%) and work (29%, with 24% of patients working from home)

Reasons related to work during the lockdown were a main cause for both worsening and improvement of headache

The authors concluded that reasons related to work were a main cause for both worsening and improvement of headache and that home working can impact differently on each patient.

What has been the impact of COVID-19 lockdown on patients with migraine in India?³

A cross-sectional, internet-based questionnaire was carried out between 27th April and 31st July 2020 to assess the impact of the COVID-19 lockdown in India on patients with migraine.

During lockdown, 51% of Indian migraine patients experienced worsening headache

The results were detailed in a poster presented by Debashish Chowdhury and colleagues.

Of the participants recruited, 4078 completed the full survey and 984 (24%) with a mean age of 35 years were physician-diagnosed migraineurs or fulfilled the criteria for a diagnosis of migraine.

Among the participants with migraine, 51% reported worsening headache, with 88–96% reporting increased attack frequency, increased headache days, increased attack duration, and increased headache severity.

The COVID-19 lockdown significantly reduced the quality of life of Indian migraine patients

The worsening headache was attributed to:

• Anxiety caused by the COVID-19 pandemic by 80%
• Inability or difficulty accessing healthcare and migraine medicines by 49%
• Financial worries by 68%

Compared with non-migraineurs, a greater proportion of migraineurs reported a bad and very bad quality of life (27% versus 7%; p<0.0001).

The authors concluded that the COVID-19 pandemic-related lockdown had significantly reduced the quality of life of Indian migraine patients.