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1.
Headache ; 62(7): 903-907, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1879033

ABSTRACT

BACKGROUND: Headache can be a prominent feature of Post-Acute Sequelae of SARS-Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection. METHODS: We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID-19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis. RESULTS: Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD-3) criteria for migraine, with 20/31 (65%) meeting ICHD-3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full-time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches. CONCLUSIONS: Our study presents a group of patients with protracted headache after COVID-19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD-3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.


Subject(s)
COVID-19 , Migraine Disorders , COVID-19/complications , Headache/epidemiology , Headache/etiology , Humans , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Migraine Disorders/etiology , RNA, Viral/therapeutic use , Retrospective Studies , SARS-CoV-2
2.
Brain Behav ; 12(5): e2588, 2022 05.
Article in English | MEDLINE | ID: covidwho-1866506

ABSTRACT

BACKGROUND: Migraine-and episodic headache-is one of the most common types of primary headache. Migraine is considered a serious health problem that affects the quality of life. During university life, students often report increased levels of stress, depression, anxiety, and irregular sleep, all of which are associated with migraines. Our aim was to determine the prevalence of migraine headaches among medical campus students at the University of Khartoum, Sudan. Based on available data, migraine is on the rise in both general populations as well as in university students. METHODS: This is a cross-sectional study. The study population was composed of students registered to the Faculty of Medicine, Dentistry, and Pharmacy at Khartoum University in the academic years of 2020-2021. Out of these, 318 of them accepted to participate. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine™ test. RESULTS: The mean age of 318 students participating in the study was 19.23 ± 1.84 (17-39 years), with adolescents:adult ratio being 2.5:1. A total of 1613 students (43.7%) had at least two headaches in the last 3 months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-Migraine™ test. Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant difference in migraine prevalence between adolescent and adult age groups. CONCLUSIONS: With prevalence similar to adults, primary care physicians should be aware of the probability of migraine headaches in university students in order to maintain a successful school performance.


Subject(s)
Academic Performance , Migraine Disorders , Students, Medical , Adolescent , Adult , Cross-Sectional Studies , Female , Headache/diagnosis , Headache/epidemiology , Humans , Male , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Prevalence , Quality of Life
3.
Headache ; 62(3): 284-293, 2022 03.
Article in English | MEDLINE | ID: covidwho-1741387

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis that has had a range of impacts on people living with migraine. METHODS: Qualitative interviews performed as part of the Migraine Clinical Outcome Assessment System project, a multi-stage Food and Drug Administration-grant funded program to develop a patient-centered core set of outcome measures for use in migraine clinical trials, offered an opportunity to explore the experience of living with migraine during the pandemic as well as to examine whether migraine treatment priorities, symptoms, and associated disability changed due to the pandemic. Semi-structured interviews were conducted in the United States between the summer and fall of 2020 with 40 individuals with self-reported, medically diagnosed migraine who self-reported that they had not tested positive for or been diagnosed with COVID-19. RESULTS: Seventy percent (n = 28) of the sample reported ≥1 pandemic-related impact on their life with migraine. Fourteen participants reported both positive and negative impacts, twelve reported negative impacts only, and two reported positive impacts only. Among those reporting ≥1 pandemic-related impact, nine participants (32%) reported more frequent and five (17%) reported less frequent migraine attacks. Other negative impacts included interrupted medical care (n = 9; 32%), and greater stress (n = 13; 46%). The most frequent positive impact reported was greater access to health care (n = 8; 29%). Ictal and interictal symptoms were not noted to change due to the pandemic, but some respondents reported less disability due to increased flexibility of schedules and reduced expectations. Treatment priorities did not change due to the pandemic. CONCLUSION: The global COVID-19 pandemic has resulted in both negative and positive impacts for people living with migraine. Lessons to be considered when moving into a post-pandemic world include benefits of and satisfaction with telehealth and the benefits and importance of healthy lifestyle habits and flexibility such as improved sleep, reduced stress, and fewer social expectations.


Subject(s)
COVID-19 , Migraine Disorders , COVID-19/epidemiology , Humans , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Migraine Disorders/therapy , Pandemics , Qualitative Research , Quality of Life , United States
4.
Headache ; 61(7): 1123-1131, 2021 07.
Article in English | MEDLINE | ID: covidwho-1324996

ABSTRACT

OBJECTIVE: To assess telehealth practice for headache visits in the United States. BACKGROUND: The rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists. METHODS: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. RESULTS: Out of 1348 members, 225 (16.7%) responded. Most were female (59.8%; 113/189). Median age was 47 (interquartile range [IQR] 37-57) (N = 154). The majority were MD/DOs (83.7%; 159/190) or NP/PAs (14.7%; 28/190), and most (65.1%; 123/189) were in academia. Years in practice were 0-3: 28; 4-10: 58; 11-20: 42; 20+: 61. Median number of telehealth visits was 120 (IQR 77.5-250) in the prior 3 months. Respondents were "comfortable/very comfortable" treating via telehealth (a) new patient with a chief complaint of headache (median, IQR 4 [3-5]); (b) follow-up for migraine (median, IQR 5 [5-5]); (c) follow-up for secondary headache (median, IQR 4 [3-4]). About half (51.1%; 97/190) offer urgent telehealth. Beyond being unable to perform procedures, top barriers were conducting parts of the neurologic exam (157/189), absence of vital signs (117/189), and socioeconomic/technologic barriers (91/189). Top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby (103/190). Only 21.3% (33/155) of providers said telehealth visit length differed from in-person visits, and 55.3% (105/190) believe that the no-show rate improved. On a 1-5 Likert scale, providers were "interested"/"very interested" in digitally prescribing headache apps (median 4, IQR 3-5) and "interested"/"very interested" in remotely monitoring patient symptoms (median 4, IQR 3-5). CONCLUSIONS: Respondents were comfortable treating patients with migraine via telehealth. They note positive attributes for patients and how access may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest and warrant future research.


Subject(s)
Attitude of Health Personnel , Headache Disorders/diagnosis , Headache Disorders/therapy , Physicians/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Migraine Disorders/diagnosis , Societies, Medical/statistics & numerical data , United States
5.
J Infect Public Health ; 14(7): 903-905, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1322215

ABSTRACT

The effect of the coronavirus disease 2019 (COVID-19) on the nervous system remains undefined. Some studies have shown that headache is one of the most common symptoms and often the first neurological symptom in patients with confirmed infection. There are only a few reports concerning the effects of COVID-19 on the course of migraine. This article investigates three female patients with prolonged history of migraine, in which atypical phenomenology and course of migraine attacks were observed during COVID-19 infection.


Subject(s)
COVID-19 , Migraine Disorders , Female , Humans , Migraine Disorders/diagnosis , SARS-CoV-2
6.
Pain Med ; 22(11): 2728-2738, 2021 11 26.
Article in English | MEDLINE | ID: covidwho-1284891

ABSTRACT

OBJECTIVE: Aim of the present observational study was to assess the impact of coronavirus disease 2019 (COVID-19) quarantine on migraine and evaluate potential influencing factors. Previous studies reported mixed results regarding clinical outcome during quarantine in patients with migraine. In particular, data from areas strongly affected by COVID-19 pandemic are missing. METHODS: One hundred and seventy patients, previously assessed at the Headache Centre-ASST Spedali Civili Brescia, underwent a telephonic interview regarding migraine features and clinical, occupational, and lifestyle variables. RESULTS: Compared to baseline, during quarantine, we found a significant overall reduction in migraine days (14.7 ± 0.6 vs 12.3 ± 0.7, P < .001), with 47.1% patients reporting a clinical improvement. Outdoor living spaces (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7-3.07, P = .009), a positive attitude throughout quarantine (OR 4.12, 95% CI 2.3-7.1, P = 0.03), working full-time (OR 1.03, 95% CI 0.5-1.9, P < .001) and a baseline diagnosis of chronic migraine (OR 1.4, 95% CI 1.1-2.02, P = 0.002) were associated with an increased chance of migraine improvement. Being single (OR 1.5, 95% CI 1.1-2.01, P = .05) and physical inactivity (OR 1.3, 95% CI 1.1-1.6, P = .02) were associated with an increased risk of worsening. CONCLUSIONS: Quarantine had an overall positive impact on migraine. Based on our results, we hypothesize the reduction of daily hassles and challenges might be the main reason for such improvement.


Subject(s)
COVID-19 , Migraine Disorders , Humans , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Migraine Disorders/prevention & control , Pandemics , Quarantine , SARS-CoV-2
7.
Cephalalgia ; 41(7): 865-870, 2021 06.
Article in English | MEDLINE | ID: covidwho-1024313

ABSTRACT

BACKGROUND: The objective of this study was to assess whether migraine-related outcomes changed during intelligent lockdown when compared with the prior period. METHODS: This was a cohort study evaluating the first month of intelligent lockdown in the Netherlands (12 March to 8 April 2020) compared with one baseline month (13 February to 11 March 2020). We identified 870 migraine patients treated at the Leiden Headache Center with headache e-diaries during the period of interest. Adherence to the e-diary had to be ≥80%, yielding 592 enrolled patients. RESULTS: Intelligent lockdown led to a decrease in monthly migraine days (-0.48; 95% CI: -0.78 to -0.18, p = 0.002) and acute medication days (-0.48; 95% CI: -0.76 to -0.20, p < 0.001), and an increase in general well-being (0.11; 95% CI: 0.06 to 0.17, p < 0.001). No differences in non-migrainous headache days and pain coping were observed. Consistent results were found in a subset that was followed for 4 months. CONCLUSIONS: Our findings imply that intelligent lockdown measures can improve migraine disability despite of the potential negative effects of COVID-19 and lockdown. We hypothesise that this effect is a combined result of working from home, scaling down demanding social lives, and freedom to choose how to organise one's time.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Medical Records , Migraine Disorders/epidemiology , Migraine Disorders/therapy , Risk Reduction Behavior , Adult , COVID-19/prevention & control , Cohort Studies , Communicable Disease Control/trends , Female , Humans , Longitudinal Studies , Male , Middle Aged , Migraine Disorders/diagnosis , Netherlands/epidemiology , Telemedicine/methods , Telemedicine/trends
8.
J Headache Pain ; 21(1): 128, 2020 Oct 29.
Article in English | MEDLINE | ID: covidwho-992434

ABSTRACT

BACKGROUND: The Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The aim of the present study was to investigate how the initial phase of the Covid-19 pandemic affected the hospital management of headache in Denmark and Norway. METHODS: All neurological departments in Denmark (n = 14) and Norway (n = 18) were invited to a questionnaire survey. The study focused on the lockdown and all questions were answered in regard to the period between March 12th and April 15th, 2020. RESULTS: The responder rate was 91% (29/32). Of the neurological departments 86% changed their headache practice during the lockdown. The most common change was a shift to more telephone consultations (86%). Video consultations were offered by 45%. The number of new headache referrals decreased. Only 36% administered botulinum toxin A treatment according to usual schemes. Sixty% reported that fewer patients were admitted for in-hospital emergency diagnostics and treatment. Among departments conducting headache research 57% had to halt ongoing projects. Overall, 54% reported that the standard of care was worse for headache patients during the pandemic. CONCLUSION: Hospital-based headache care and research was impacted in Denmark and Norway during the initial phase of the Covid-19-pandemic.


Subject(s)
Coronavirus Infections , Delivery of Health Care , Headache Disorders/therapy , Neurology , Pandemics , Pneumonia, Viral , Telemedicine/statistics & numerical data , Betacoronavirus , Botulinum Toxins, Type A/therapeutic use , COVID-19 , Cluster Headache/diagnosis , Cluster Headache/therapy , Denmark , Disease Management , Headache/diagnosis , Headache/therapy , Headache Disorders/diagnosis , Hospital Departments , Hospitalization/statistics & numerical data , Humans , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Neuromuscular Agents/therapeutic use , Norway , Outpatient Clinics, Hospital , Referral and Consultation , SARS-CoV-2 , Surveys and Questionnaires , Telecommunications/statistics & numerical data , Videoconferencing/statistics & numerical data
9.
Headache ; 60(8): 1788-1792, 2020 09.
Article in English | MEDLINE | ID: covidwho-714357

ABSTRACT

Headache was reported in up to one-third of the hospitalized patients; yet, the clinical characteristics of headache associated with coronavirus disease 2019 (COVID-19) have not been defined. This observational case study included patients who were consulted to headache unit due to headache and had COVID-19 illness. Headache features in 13 PCR-confirmed COVID-19 patients with mild symptoms were reported. Headache was the isolated symptom of the COVID-19 in 3 patients and emerged as an early symptom during the disease course in all patients. Patients specified severe, rapid onset, unrelenting headache with migraine-like features, as well as unusual sensory symptoms such as anosmia, and gastrointestinal symptoms such as diarrhea and loss of appetite and weight. Headache lasted up to 3 days in 70% of the patients and resolved in all patients within 2 weeks. Despite the fact that most of the patients were female and headache characteristics were suggestive of migraine, majority of patients were not suffering from primary headaches. It was concluded that headache could be an isolated symptom of COVID-19, which might possibly be ignored in asymptomatic patients. Headaches associated with COVID-19 included features resembling migraine and/or atypical symptoms including anosmia and diarrhea.


Subject(s)
COVID-19/complications , Headache Disorders, Secondary/etiology , Pandemics , SARS-CoV-2 , Adult , Anorexia/etiology , Asymptomatic Infections , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Diagnosis, Differential , Diarrhea/etiology , Female , Headache Disorders, Secondary/epidemiology , Humans , Male , Middle Aged , Migraine Disorders/diagnosis , Sensation Disorders/etiology , Symptom Assessment , Weight Loss
10.
Headache ; 60(8): 1773-1776, 2020 09.
Article in English | MEDLINE | ID: covidwho-592226

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has now affected more than 5 million people globally. Typical symptoms include fever, cough, and shortness of breath. Patients with underlying medical comorbidities such as cardiovascular disease and diabetes are more likely to become severely ill. To date there is limited information on how COVID-19 affects patients with a history migraine. Here, we present the cases of 2 women with a history of migraine whose first symptom of COVID-19 was a severe persistent headache.


Subject(s)
Asymptomatic Infections , COVID-19/complications , Headache Disorders, Secondary/etiology , Headache Disorders/etiology , Migraine Disorders/complications , SARS-CoV-2/isolation & purification , Adult , Analgesics/therapeutic use , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Diagnosis, Differential , Female , Fever/etiology , Headache Disorders/diagnosis , Headache Disorders/drug therapy , Headache Disorders, Secondary/drug therapy , Humans , Migraine Disorders/diagnosis , Nasopharynx/virology , Pandemics , Polymerase Chain Reaction , Time Factors
11.
Headache ; 60(6): 1183-1186, 2020 06.
Article in English | MEDLINE | ID: covidwho-155342

ABSTRACT

The COVID-19 pandemic has undoubtedly changed our practice of medicine. With our collective resources and attention focused on caring for those afflicted with the disease, other medical conditions have temporarily but understandably faced constraint. For migraine patients who often require in-person visits for infusions and procedures, this has become particularly challenging. Here, we share our experience in navigating this exigency amidst a local surge of COVID-19.


Subject(s)
Betacoronavirus , Botulinum Toxins, Type A/administration & dosage , Coronavirus Infections , Migraine Disorders/drug therapy , Pandemics , Pneumonia, Viral , Time-to-Treatment/trends , Adult , COVID-19 , Coronavirus Infections/psychology , Female , Humans , Middle Aged , Migraine Disorders/diagnosis , Migraine Disorders/psychology , Pneumonia, Viral/psychology , SARS-CoV-2 , Treatment Outcome
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