From the time she was 11, Kimberly Cofield has had frequent migraine headaches. At first, they were often triggered by certain smells. As Cofield got older, they coincided with stress and her menstrual periods. For many years, she had a migraine about 23 days a month. Eventually, after finding the right medications, she had fewer attacks and they were less severe.
Then the COVID-19 pandemic arrived, and Cofield's life, like everyone else's, shifted dramatically. She began working from home, her company started laying off employees, her workload increased significantly, and she became socially isolated. “My stress went through the roof,” says Cofield, 46, director of product development for a health care company in Simi Valley, CA. Given the stress, she wasn't surprised when she began having more migraine episodes. They also became harder to treat, even though she takes two preventive drugs and another to treat acute flare-ups. “Now my migraines are a little more intense and they last longer—I can't shake them,” Cofield says. “And they're interfering with my daily life because they're so persistent.”
Romance novelist De De Cox, who works as a paralegal in Louisville, KY, has also experienced a worsening of migraine symptoms during the pandemic. Before COVID-19 shut things down, she had occasional migraine attacks, just like her mother and sister. Since then, her attacks have increased in frequency from about once a month to once a week and are often accompanied by nausea and vomiting. “There's been intense pressure to keep the law firm running while we're working from home, but without being face-to-face, communication sometimes gets messed up, and the changes in routine have been hard,” says Cox, 58, whose mother has dementia. “Nothing has been easy during the pandemic.”
Cox and Cofield are not the only ones seeing a worsening of migraine symptoms. According to an online survey published in the Journal of Headache and Pain last September, 60 percent of 1,018 adult respondents reported an increase in migraine frequency during the pandemic, and 10 percent said their episodic migraine attacks had become chronic.
The pandemic has activated many migraine triggers, says Mark W. Green, MD, FAAN, emeritus director of the Mount Sinai Center for Headache and Pain Medicine in New York City. “If you have migraine, your brain may respond to stress with a disabling headache. If you're unemployed, not sleeping well, or worried about contracting COVID-19—any of these could trigger an attack,” he says. “Change is often difficult for those with migraine. A lot of our timing, which used to be tied to our work schedules, has fallen by the wayside.”
For some people, the lockdown has eased conditions that can cause migraines: Working from home allows them to eat regularly, stay hydrated, and take breaks to stretch, and they don't have to deal with commuting or traffic. A study conducted in Italy and published in Frontiers in Neurology in November found that people with migraine experienced a mild decrease in the frequency and severity of their headaches during the spring 2020 quarantine compared with the two months preceding the pandemic.
But other patients with migraine say the pandemic has made it challenging to get the care they need. Nechama Moring, 39, a grant writer in Boston, has had migraine since childhood, but her headaches worsened two years ago after she sustained a head injury. She takes a preventive medicine and uses triptans for acute attacks, but she often finds the drugs are inadequate. “The pandemic has created delays in treatment,” says Moring. “I want to make changes in my medication, but I haven't been able to [get an appointment to] see a doctor who will help me with that.”
For still others, the coronavirus itself has triggered new headaches. Between 68 and 75 percent of people who visited emergency departments for COVID-19 reported headache among their symptoms, according to studies published last year in the journals Headache and Cephalalgia. Cephalalgia's study also showed that 25 percent of people had severe head pain with migraine-like characteristics.
“The headache can be due to direct viral infection of the nervous system, psychological stress, or fever,” says Randolph W. Evans, MD, FAAN, clinical professor of neurology at Baylor College of Medicine in Houston. “The migraine-like features associated with COVID-19 may be due to inflammation or the virus affecting the trigemino-vascular system, which is the part of the brain believed to turn on migraine.”
Unlike migraine flare-ups, which typically involve throbbing pain on one side of the head and are often associated with nausea or sensitivity to light, COVID-19 headaches are usually characterized by a feeling of pressure on both sides of the head, says Rob Cowan, MD, FAAN, endowed professor of neurology and neurosciences at the Stanford University School of Medicine.
But many people, even those without a previous history of headache, have had ongoing head pain six weeks after contracting COVID-19. “We are seeing that the virus can trigger new daily, persistent headaches with a migraine-like quality in people without a history of migraine,” says Nina Riggins, MD, PhD, FAAN, associate professor of neurology at the University of California, San Francisco. Persistent headache also is a common symptom of COVID-19 long-haul syndrome, for which more research is needed, says Teshamae Monteith, MD, FAAN, associate professor of neurology at the University of Miami Miller School of Medicine in Florida.
For people with a history of migraine who contract COVID-19, the pattern of head pain has been slightly different: It starts at the onset of COVID-19 respiratory symptoms, lasts longer, and is more intense than in those without migraine, according to the 2020 study published in Headache. “Any time a patient with migraine has a viral or bacterial infection, it ramps up immune function and you tend to see an increase in migraine flare-ups and severity,” says Jessica Ailani, MD, FAAN, director of the Medstar Georgetown University Hospital Headache Center in Washington, DC. “Migraine is hard to control while you're sick.” Flare-ups may not respond as well to medication when the patient is ill, Dr. Ailani says.
Medication can make a big difference, however, when a patient is otherwise healthy. “We learned a long time ago that the more migraines you have, the more they'll increase over time,” says Dr. Green. “Treating attacks can reduce the chance of progression.” He and other specialists recommend taking preventive drugs if you have more than six migraine attacks per month and are using acute medications to relieve flare-ups.
People should also do what they can to avoid or mitigate triggers. After Misty Pratt, 40, an Ottawa health researcher and mother of two school-age kids, realized that excessive screen time and stress were triggering her attacks, she started practicing yoga regularly and having monthly massages. She's now considering getting a standing desk.
“It's important to take breaks from the screens,” says Dr. Riggins, who recommends glasses or filters that block the blue light emanating from computer screens. Wearing the glasses in the evening advances the release of melatonin (a hormone that signals it's time to sleep) and facilitates the onset of sleep on workdays, according to research in the June 2020 issue of the European Journal of Neuroscience.
Self-care has been an even bigger priority for Cofield during the pandemic. She takes online yoga and Pilates classes, which help her relax and sleep better; walks her dog; and hikes and mountain bikes. She also eats more healthfully at home than she did in the office, where she often bought snacks from the vending machine. Not commuting means she can keep a more consistent schedule and nap when she needs to.
The pandemic has upended life, but it's an opportunity to create a predictable schedule, says Dr. Cowan, who encourages people with migraine to always try to cultivate calm and steadiness. “Healthy habits such as following a good diet, getting adequate sleep, and reducing stress are critically important on that front.”
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