Migraine: even more of a headache during pandemic

“That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing,“ writes American author Joan Didion in her essay ‘In Bed’.

It’s a sentiment many, including myself, will truly understand, for a migraine is not merely a sore head, it is one of the four most disabling chronic medical conditions.

And it seems the pandemic has compounded the severity of symptoms and/or increase in frequency of attacks for many sufferers.

According to the Migraine Trust many people will have experienced some stress and anxiety over the last few months.

The charity said that although it’s a normal reaction to the situation we all find ourselves in, for people with migraine the implication of this stress and anxiety may be an increase in attacks; or more anxiety and stress about the thought of the situation triggering an attack.

I have been plagued by these monstrous headaches for the last 30-something years. Initially they were accompanied by aura, zigzagging lines, like a television screen on the blink. On other occasions my eyesight would slowly go black, like treacle spreading over my vision.

There were aural disturbances too; voices sounded like they were in an echo chamber or had been put through a voice-changing machine.

Thankfully, I no longer get the aura, but I do get incredibly dizzy, my body goes numb, light and sound are intolerable, then there’s the fleeting relief afforded by being by being extremely sick.

This is followed by a headache. A pain that feels like my skull is being drilled by some instrument of torture; crushing, pulsing pain, with no relief, tightening around my crown like a metallic Alice band. The pain can last for days. On some occasions, weeks. I can’t see properly, think coherently or entirely understand speech. It’s a gentle madness

But by the standards of many migraineurs (the name given to those of us who experience the horrors of this condition), I am lucky. I have a few attacks a year. It is thought 10 per cent of sufferers get them weekly, and 14 per cent more than 15 days a month. When Joan Didion was writing in 1968, she was losing four days a week to her headache.

Since the pandemic began I’ve only had two attacks, but they were shockingly bad and I’d safely say much worse than the ones I get in ‘normal’ times.

Many people know what triggers their attacks, but I’m not sure what causes mine - there doesn’t seem to be a rhyme or reason - the classic culprits of chocolate, cheese and red wine, don’t seem to affect me, but I’m sure stress does play a part.

Dr Kay Kennis, a GP with a special interest in headache and trustee of the Migraine Trust said: “We know that many people with migraine experience low mood from time to time. The current coronavirus situation is likely to be making this more challenging, especially as appointments are cancelled and it’s not clear when things will return to normal.

“If you are feeling low you may benefit from speaking to someone – you may want to talk to a friend or family member. If you don’t feel comfortable with this you can contact Samaritans (24/7) on 116 123. The NHS Every Mind Matters site has a range of resources you may find helpful as well.

“If you are having thoughts about harming yourself you should contact your GP urgently (or 111 if out of hours). Most areas in the UK have a 24-hour support service for urgent psychological support you can be re-directed to.”

Dr Kennis added: “For those with migraine, stress, anxiety and depression can act as a ‘double whammy’, as they usually make migraine worse or can trigger a migraine. They also make us less able to cope with the physical and emotional problems we have.

“If you are feeling stressed, anxious or depressed it’s important to ask for help. You may feel that the situation isn’t serious enough, or that you don’t want to ‘bother’ your GP. However, it’s really important to seek help when you need it, and it’s important to persevere.”

Dr Kennis said many people successfully manage their migraine, and that good self-care can help with migraine management.

“It may seem more challenging at the moment because of the circumstances you find yourself in, but there are lots of things you can do to self-manage your migraine during Coronavirus (and beyond).If you already have good self-care management in place, keep doing what you’re doing. Although be aware it may need a bit more effort at the moment.”

However, Dr Kennis added: “We know that some people are finding their migraines have got worse or increased in frequency during the current crisis, and we also know many people don’t want to contact their GP unnecessarily.

“If you experience an increase in the number of migraine you should try to self-manage at home (as much as you can) initially. If this doesn’t improve your migraine you should contact your GP for advice. If you get new or different types of migraine, you should contact your GP straight away and ask for a review. At the moment to access the GP most people have to tell the receptionist about their problem, or fill in an online e-consult form. Make sure you tell them that this migraine is new or different to your usual ones so the doctor knows this needs urgent review.

“Some headaches will need emergency assessment in hospital so don’t wait for your GP to open if you have a sudden onset severe headache, a headache associated with fever, or headache with part of the body not feeling or moving properly that has never happened before.”

Dr Kennis said some people with migraine may have had their outpatient treatment appointments, including Botox and Greater Occipital Nerve (GON) blocks, cancelled or postponed.

“This is very difficult for a lot of people at the moment. When it comes to trying to manage the impact of this the main thing is to try not to go backwards. Do not take simple painkillers like Paracetamol or Ibuprofen on more than 15 days of the month. Don’t take Triptans on more than 10 days / month. Avoid opiates like Codeine.”

Migraines are horrible and you can truly only understand how horrible if you are also a sufferer. On the bright side the days after a migraine are euphoric. The release from pain and the hazy migrainous filter is truly amazing. It would still be nice not to get them though.

*The Migraine Trust information line is open Tuesday and Thursday 10am – 4pm on 0203 9510 150 (option 1).

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