The COVID-19 pandemic — which was officially declared in March 2020 and is still ongoing in 2022 — has added a new layer of stress and uncertainty to life in general, making it even more difficult for many to manage all those daily concerns. Grocery shopping, doctor’s visits — and pretty much everything else that takes “getting from here to there” — requires more planning, and often involves a risk-to-reward assessment. For many people with migraine, it didn’t take long for the pandemic to have a negative effect, according to an online survey conducted during July 2020. A total of 1,018 people responded to the survey, the results of which were published in September 2020 in The Journal of Headache and Pain, and about 3 out of 5 of those respondents reported an increase in migraine frequency, compared with only 16 percent who had a decrease in the number of attacks. In addition, a little more than 10 percent of respondents reported converting from episodic to chronic migraine, defined as 15 or more headache days a month. The added stress of the COVID-19 pandemic continues to make life more challenging for everyone, but there are people, organizations, and ideas that can help. Here are some tips on staying safe and healthy while living through the pandemic while having migraine. But there are questions about the lingering effects COVID-19 may have on chronic conditions, including migraine: Could they make some symptoms worse for a while, even after recovery — and if so, for how long? Research on this topic is in the early stages, but more will certainly be known in the months and years to come.
Does Having Migraine Put You at a Higher Risk of Contracting COVID-19?
There isn’t any evidence to suggest that people who have a history of migraine are at a higher risk of acquiring COVID-19, or of having more complications if infected with the virus, according to Katherine Hamilton, MD, an assistant professor of neurology at Medstar Georgetown University Hospital in Washington, DC. “At this point we don’t have any hard data that having migraine would have any effect on the immune system or predispose someone to getting COVID-19,” Dr. Hamilton says. “There are a few risk factors for COVID-19 that are slightly more common in people with migraine, such as obesity and certain autoimmune conditions, but overall there isn’t a significant signal or trend that would be concerning regarding COVID-19 in the migraine population,” says Hamilton. Migraine tends to be more common when people are younger. The peak age range for migraine is usually twenties to forties, says Hamilton. “So, the fact that most migraine patients are younger would make them less susceptible to COVID-19 or to severe symptoms of COVID-19, compared with older people,” she says. That is not to suggest that migraine protects people from COVID-19 in any way; it simply reflects the fact that the typical migraine population is within an age range that has experienced far fewer catastrophic cases of COVID-19, says Hamilton.
Does Having Migraine Increase Your Risk of Developing Long COVID?
Long COVID is a condition in which new or ongoing symptoms last for weeks or months after a COVID-19 infection. It can develop even in people who were only mildly ill with the initial infection. Symptoms include shortness of breath, fatigue, difficulty thinking or concentrating, headache, and more. “As far as I know, there are no studies or indication that people who have a history of migraine would be more likely to have long COVID,” says Hamilton. “If we are just talking about headache as a symptom of COVID, it could be more likely that it may linger past the acute infection phase in some people with migraine, but that continues to be explored,” Hamilton adds. “I definitely recommend that everyone who is eligible — and that includes people with migraine — get the COVID-19 vaccine series and the booster. Although having migraine doesn’t appear to increase the risk of severe COVID-19, many people with migraine have comorbidities [additional medical conditions] that could put them at higher risk,” she says. Some of the common chronic illnesses that raise the risk of severe illness from COVID-19 include diabetes, heart disease, and obesity.
How Will Your Migraine Be Affected if You Test Positive for COVID-19?
The accumulating research on the symptoms and manifestations of COVID-19 indicates that headache is a common symptom of COVID-19, says Hamilton. “There is some evidence to suggest that people with migraine may be more likely to have headache as one of their symptoms if they do contract COVID-19, but the data is mixed on that,” she says. “Based on my experience and the experiences that other headache specialists have shared with me, it appears that in patients who suffer from migraine who get the virus, it tends to cause a very severe headache or migraine,” says Hamilton. This makes sense, because when you have migraine, any additional illness you may acquire can potentially predispose you to getting a migraine attack, she says. “We also know that COVID-19 can cause headache regardless of migraine, and so it stands to reason that if you have a history of migraine, you may be even more likely to develop headache or severe headache,” she says. “What I’ve heard from my patients, and what I’ve heard from other headache specialists, is that when people with migraine get headache with COVID-19, it often is very severe — much more severe than their typical migraine, and very difficult to treat,” says Hamilton. In addition, most doctors now have much more experience treating their migraine patients via telemedicine than they did before the pandemic. Together, these advances in knowledge and experience can help you to avoid any interruptions to your migraine treatment. “At this point, there aren’t really any concerns for using typical migraine medications in the context of COVID-19 or the vaccine,” says Hamilton. When the vaccine first came out, there were theoretical concerns over some migraine medications, such as calcitonin gene-related peptide antibodies and Botox, but ill effects or interactions with the vaccine and those medications have not be observed, she says. “There was some hesitancy about steroid use early in the pandemic, but steroids have actually been studied as a potential treatment for severe COVID-19 symptoms, and so I don’t think we’re as hesitant to use steroids in the case of severe migraine that could be from COVID-19,” says Hamilton. Concerns have also been raised over the use of a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which are sometimes used off-label for the prophylactic (preventive) treatment of migraine, says Hamilton. Off-label use, in this case, means the drug hasn’t specifically been approved for preventing migraine attacks. But, says Hamilton, “there was a position paper published in April 2020 in The Journal of Headache Pain that specifically addressed concerns over ACE inhibitors and ibuprofen and found no reason to avoid these medications for the treatment of migraine, based on the available evidence.”
What Resources Are Available if You Can No Longer Afford Your Medications?
COVID-19 has meant a loss or change in health insurance for many people, says Hamilton. “Managing medication costs can be complicated, and every case is a little bit different, so it’s a good idea to talk with your doctor to find solutions,” she says. “Sometimes even just switching health insurance — for example switching to a spouse’s insurance — can lead to delays in care if you have to restart authorizations or need to change medications if different drugs are covered or not covered by the new plan,” she says. If a person is on a medication that is no longer covered by insurance and would be expensive to pay for out of pocket, there are assistance programs that are offered by the drug manufacturers, says Hamilton. “Those programs can usually be found on the medication producer’s website, so sometimes I’ll direct patients there,” Hamilton says. Additional online resources that can help you navigate the costs of migraine treatment are the Coalition for Headache and Migraine Patients and GoodRx, where discount coupons and price comparisons among local pharmacies are available.
What Can Someone With Migraine Take to Safely Boost Their Immune System?
There isn’t evidence that people with migraine can take any sort of supplement to boost their immune system to fight off the novel coronavirus, says Hamilton. “However, if people are vitamin D deficient, they might want to talk with their provider about taking a supplement, as there has been some recent evidence that lower vitamin D levels may be associated with poorer outcomes in COVID-19,” she says. An analysis published in May 2020 the Irish Medical Journal suggests that vitamin D deficiency may lead to an increased risk of contracting COVID-19 and of dying from it. The researchers suggest that optimizing one’s level of vitamin D is likely to have benefits where COVID-19 is concerned. “Maintaining regular exercise, good sleep, and practicing a healthy lifestyle are probably the most important factors in keeping the immune system strong and fending off infections in general,” says Hamilton.
Can Stress and Anxiety About Coronavirus Make Migraine Worse? How About Depression or Lack of Sleep?
Stress is definitely one reason migraine symptoms might be worse during the COVID-19 pandemic, says Hamilton. “We know that stress is the biggest trigger of migraine and that it can contribute to poor sleep, which can also lead to worse migraine,” she says. “There’s a lot of uncertainty now, which can lead to this constant, low-level stress. Even those people who are lucky enough to have job security and aren’t feeling those more acute stresses of COVID-19 are faced with uncertainty on a constant daily basis,” she says. Stress is also associated with depression and anxiety, conditions that are more common among people with migraine, says Hamilton. According to a paper published in May 2019 the The Journal of Headache and Pain, depression is almost twice as common in people with migraine as in the general population. “The stress due to COVID-19 could make the migraine population particularly vulnerable to depression during this time,” she says. “I think it’s good that there seems to be a lot of public awareness about mental health right now,” says Hamilton. The pandemic has presented challenges for people with migraine, which can be made worse because people can’t see their regular therapist in person anymore, she says. “I advise people to utilize available resources through telemedicine — the use of phone, video, or email to connect with a provider of medical care — or find a call center or support online,” says Hamilton. “If you don’t have a mental health professional on your healthcare team, most doctors who treat migraine have experience treating people with mood disorders or at least referring people for treatment,” says Hamilton. “They can be a potential resource to speak with if you are experiencing worsening anxiety or depression,” she says.
Should You See Your Doctor in Person, or Stick With Telemedicine?
When many parts of the country were shut down in early 2020, the utilization of telemedicine skyrocketed. But with the authorization of the COVID-19 vaccines, along with the increased availability of COVID-19 tests, most health systems have resumed in-person visits — with preventive precautions in place. Whether or not to choose in-person appointments for migraine can depend on several factors, including the preference of the patient and the doctor and what they feel comfortable with, Hamilton says. Telemedicine, or virtual visits, are an excellent alternative to in-person appointments during a pandemic, when there is risk associated with leaving your home. “My sense is that for most providers, telemedicine is still an option to some extent. In my practice, I am still using telemedicine, primarily as a way to follow up with patients,” says Hamilton. A virtual visit can also be a good option for a patient who has had a recent COVID exposure or is having symptoms, she says.
Are There Any Extra Precautions to Take for In-Person Appointments?
“People with migraine should follow the CDC guidelines for the general public for minimizing risk,” says Hamilton. “In addition to being fully vaccinated, we recommend that all patients wear face coverings and come to the appointment alone, unless it’s medically necessary for them to be accompanied by someone,” she says.
Are Virtual Doctor Visits as Effective as In-Person Visits?
“Generally speaking, I think that in migraine care and headache care, a virtual visit can be just as effective as an in-person visit,” says Hamilton. In the case of a follow-up appointment, a virtual visit may actually be preferable to an in-person visit, she says. “These visits can involve changing doses of medication or starting or stopping new medications, but often it’s more of a discussion with the patient and doesn’t require an examination or any sort of in-person procedure,” she says. Doing a virtual appointment can be much more convenient for many people, says Hamilton. “A lot of patients have to travel a significant distance to see a headache specialist; the option of having a virtual visit in these situations can improve access,” she says. A study published in October 2019 in Cephalalgia found that telemedicine was an effective way to conduct follow-up evaluations for people with migraine, and that virtual visits could improve both patient access to care and physician productivity.
What Types of Appointments Should You Do Virtually vs. In-Office?
The availability of virtual visits can vary from office to office, and part of this is based on whether or not insurance will continue to cover the cost of the appointment, says Hamilton. Call your provider to find out what type of visit they recommend. Procedures such Botox injections require an in-person visit. Preventive medications such as Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab) may be given in the office as monthly injections, although they can also be given as self-injections at home, with proper training. Administration of the preventive drug Vyepti (eptinezumab) requires an office visit since it is given intravenously, every three months.
What to Expect at a Telehealth Migraine Appointment and How to Get Prepared
A telehealth visit should mimic an in-person clinic visit in terms of the attention you give it and the time you set aside to prepare. Similarly, you can expect your healthcare provider to focus exclusively on you and your health needs for the duration of the appointment. “I advise patients to have the telemedicine appointment when they are at home in a relatively quiet, stable situation,” Hamilton says. Avoid scheduling an appointment when you are likely to be at work, cooking dinner, or driving — or any other time when you know you’ll be distracted. Also, “Make sure you are ready at the time of your appointment with any questions or concerns you may have,” Hamilton adds. It may help to familiarize yourself with the log-in requirements of your provider’s telemedicine system ahead of time, so that you have any information or devices you may need on hand when it’s time for the appointment. “Along with having compassion for yourself, make sure you’re taking care of yourself, both emotionally and physically,” says Hamilton. Take the time to stay connected with family and friends, exercise, get good sleep, and eat healthfully. “Also, stay aware if your mood worsens and you need to check in with your doctor or a mental health professional,” she says. The American Migraine Foundation offers these tips to help people with migraine get through the COVID-19 pandemic:
Try to work with your doctor and insurance company to make sure you have an adequate supply of your acute and rescue medications, as well as any preventive medications that you may need.Make an effort to stick to a regular schedule for when you eat and sleep.Use technology to stay connected and check in with friends and family.
The American Migraine Foundation is a nonprofit foundation working to improve migraine through research and awareness. The organization offers tips and resources for people with migraine during the COVID-19 pandemic.Move Against Migraine is a Facebook group sponsored by the American Migraine Foundation that provides support, the latest information about clinical trials, and professional advice about migraine and COVID-19.The American Headache Society works to improve the lives of people affected by migraine and other headache disorders. There are tip sheets and webinars that offer recommendations for how to live with migraine in the time of COVID-19.John R. Graham Headache Center at Brigham and Women’s Faulkner Hospital in Boston offers a resource page for people with migraine during the pandemic that includes lifestyle tips and free virtual mindfulness sessions.The Global Healthy Living Foundation, a nonprofit whose mission is to improve quality of life for people with chronic illness, has created a guide for migraine patients and COVID-19.
