Why does it seem that people are getting more migraines during the pandemic?

TV host and model Bianca Gonzalez-Intal has been coping with migraines and taking maintenance medicine for almost 30 years.

“I was in school. I went to the clinic. My head was throbbing. Tinawag ‘yung mommy ko (My mom was contacted) to pick me up from school. [Then], I remember going to the hospital and doing some tests,” Ms. Gonzalez-Intal recalled when she first got diagnosed with a migraine in Grade 3.

As an adult, she takes strong medicine and naps prior to her work as a host to cope. “Whenever I had to host shows and events, there were bright lights and loud sounds, which are all migraine triggers. I have to take a strong medicine and take a nap backstage before showtime, so I could ease my migraine headache and be able to perform my role as host,” she said.

Aside from sounds and lights, a major trigger for migraines is anxiety. And being in the middle of a pandemic is stressful.

MIGRAINES AND THE PANDEMIC
Migraine is a headache disorder involving recurrent attacks of moderate to severe head pain, usually throbbing, often on one side of the head. Stress, lack of sleep, and strong odors are some of its common triggers.

According to the Global Burden of Disease Study 2016, around 12 million Filipinos suffer from migraine.

The pandemic has hit migraine sufferers hard. Swiss pharmaceutical company Novartis conducted a social media analysis of 3,645 posts (in English) from March 15 to April 15 this year which found that the stress and anxiety induced by the COVID-19 (coronavirus disease 2019) pandemic have triggered migraine attacks in patients globally.

“Migraine attacks may be more common these days because of stress and anxiety caused by the pandemic,” said Dr. Corina Maria Socorro Azores-Macalintal, consultant neurologist at Asian Hospital and Medical Center, said in a virtual media briefing, “Tama Na, Iwas Migraine, New Normal,” organized by Novartis Healthcare Phils., and held via Zoom on May 27. “The impact of the pandemic on the patient is more on the limitations of the patient’s access to health care, and their increase in stress and anxiety as the triggers for their migraine,” she said.

During the briefing, medical professionals discussed how migraine patients can cope amidst the COVID-19 pandemic, including resorting to telemedicine and other online resources for help.

The biggest culprit during the pandemic, said Philippine Neurological Association (PNA) President Dr. Rosalina Espiritu-Picar, during the briefing, is sleep issues. “The biggest problem with having an unstructured life because of the pandemic is that you don’t have regular working hours so sleep is also very irregular,” she said.

Anxiety and depression caused by the pandemic can be part of a vicious circle involving sleep problems and migraine pain. “They feed off each other,” said Dr. Espiritu-Picar. “That means people who do not sleep well tend to have more pain, and people who end to have more pain also tend to have more anxiety and depression. And that relationship is bidirectional,” she noted.

“The limitations imposed by the COVID-19 pandemic have impacted patients globally, including migraine sufferers. To cope with these limitations, we encourage migraine patients who are stable and do not require acute emergency care to utilize telemedicine tools so that they can stay connected with their doctors,” Dr. Espiritu-Picar said.

To give patients more information about migraines and headaches while maintaining safety protocols during the quarantine, the PNA posted a list of neurologists who are accepting telemedicine consultations on its official website (www.philippineneurologicalassociation.com), as well as a list of FAQs about headaches (https://www.philippineneurologicalassociation.com/headache).

While patients may be prescribed pharmacologic managements such as analgesics, triptans, and medicine combinations, Dr. Azores-Macalintal noted that non-pharmacologic managements such as staying hydrated, regular exercise, regular sleep, and stress management, are also important.

It is also advised to avoid food, behavioral, and environmental triggers. Food triggers include caffeine, alcohol, and monosodium glutamate (MSG); behavioral triggers include stress, too much or too little sleep, skipping meals, and dehydration; and environmental triggers include weather changes, loud noise, and exposure to glare or flickering lights like those that affect Ms. Gonzalez-Intal.

Different patients have different triggers, and one can discover which ones are particular to them by tracking their migraines. One way to do so is with Migraine Buddy, an advanced migraine headache diary and tracking app designed with neurologists and data scientists. Through the app one can not just learn what their particular triggers are, but also learn to recognize the warning signs. It is available on the App Store and Google Play.

MEDICATION
Aside from avoiding triggers, there are now medical options that can be taken to prevent migraines. One of these is Novartis’ Erenumab, which has been approved by the US FDA, EMA, Swissmedic and Australian Therapeutic Goods Administration for migraine prevention.

“Erenumab specifically targets the calcitonin gene-related peptide or CGRP receptor, which plays a key role in the pathophysiology of migraine. It has been shown to safely and effectively reduce migraine frequency, allowing patients to have more migraine-free days. This innovative anti-migraine medicine is self-administered once monthly via a pre-filled syringe,” Chief Scientific Officer of Novartis Healthcare Philippines Dr. Giovell Barangan said in a press release.

In the Philippines, it has been approved and prescribed for the prevention of migraine among adults. “The effectiveness has not been studied in the pediatric population that’s why it is only recommended for adult patients with migraine,” he said during the virtual media briefing. “It can only be purchased with a doctor’s prescription and guidance.”

“You have to understand that there are different kinds of headaches. Different headaches have different manifestations,” Dr. Espiritu-Picar said, adding the importance of consultations because various headaches require different treatments. She also advised patients to develop an active partnership with their doctors. “A big part of the management of migraine will depend on the patient’s cooperation,” she said.

To learn more about migraine and be in contact with fellow migraine sufferers, visit the Speak Your Migraine Facebook page at https://www.facebook.com/speakyourmigraineph. — Michelle Anne P. Soliman