Timely diagnosis and appropriate management can lead to a significant improvement in the quality of life, says Dr Sumit Singh
Migraine is considered one of the most disabling chronic neurological diseases, and patients with migraine are particularly vulnerable to the drastic negative impacts of the pandemic. But there is a more severe condition known as chronic migraine, in which an individual gets headaches more often. According to the International Headache Society, chronic migraine is defined as a headache occurring for 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of a migraine headache.
Currently, there are three practical clinical criteria to classify or diagnose chronic migraine. First, a headache that lasts for four or more days for three months. Second, headaches that last for more than 15 days in a month and lastly, headaches that last for more than eight days with at least two of the following four characteristics- unilateral location, pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity and at least one of the following: nausea and/or vomiting, photophobia and phonophobia.
The COVID-19 pandemic emerged rapidly. Owing to challenges faced by people during the pandemic and multiple lockdowns, patients with chronic migraine are reporting an increase in frequency of headaches. With the overwhelmed health systems and the need to stay protected, patients are minimizing their visits to clinics and emergency departments.
A recent online survey explored the real-world impact of COVID-19 on patients with migraine and showed that about 60 per cent of respondents had an increase in migraine frequency, 16 per cent reported a decrease in migraine frequency, and a little over 10 per cent reported converting from episodic migraine to chronic migraine.
Many patients have been hesitant to visit doctors fearing the COVID-19 infection, and many local clinics were temporarily shut down to avoid crowding and spreading of infection. As a result, many in-person doctor visits were cancelled leading to consumption of excessive pain killers and medications. During the pandemic, triggers that were noted included increase in screen time, change in sleep time, increased consumption of caffeine and alcohol along with dietary changes.
Potentially remediable risk factors for chronic migraine include frequency of migraine attacks, obesity, excessive use of medications containing opioids and barbiturates, caffeine overuse, stressful life events, depression, sleep disorders etc. Several studies found that psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance of locus of control were associated with chronic migraine.
Chronic migraine is an under-recognised and under-treated disorder. Timely diagnosis and appropriate management can lead to a significant improvement in the quality of life. Also, there is a lack of awareness about the seriousness of migraine and transformation to chronic migraine.
As the pandemic created the gap in the treatment schedule, telemedicine should be practiced catering to concerns and fear of exposure to the Covid19 virus. Regular and periodic consultations will optimise therapy. Great effort must be made to facilitate therapies that can be availed at home effectively so that the chances of visits to the emergency department or the clinic are minimised.
One should immediately consult a neurologist, and should not overlook the symptoms like pounding, throbbing, or pulsating, severe pain on one side of the head (unilateral) or both (bilateral) focused on the front or back of the head, or both, around the eyes or behind the cheeks along with one of the following effects of Nausea, vomiting or both, sensitivity to light and sound.
Experts feel the need for more patient-centric programmes aimed at educating them, about the various treatments available and to understand new therapies.
The Writer Dr Sumit Singh, Chief Neurologist, at Artemis Hospital, Gurgaon