Migraine and Covid-19

How Covid-related stress and changes to your routine could make migraine worse

Did the start of the Covid-19 pandemic lead to more migraine attacks?

We know from a recent poll that many people with migraine saw an increase in their attacks around the time that the Covid-19 pandemic triggered the first national lockdown.

This may be due to a number of factors.

The brain of a person with migraine is sensitive to change, and the impact of the new coronavirus resulted in plenty of lifestyle changes that could trigger migraine. These changes may internal or external – and lockdowns affected our lives lots of ways.

Sleep routines may have altered as we began to work from home more and schools were closed. Anxiety, stress and low mood may all have contributed to restless sleep.

Mealtimes may also have been disrupted, with the temptation to snack, cravings for comfort food and the simplicity of takeaways leading to a change in the balance of carbohydrates, fat and protein. Alcohol and caffeine intake may also have increased.

Some people reacted to confinement by exercising more than usual, whereas others may have found their lives more sedentary.

All these changes can impact and irritate the brain of someone with migraine.

To minimise the impact of migraine, we recommend the following.

• Stick to a routine sleep pattern wherever possible – go to sleep and wake at the same time every day, weekends included
• Once awake in the morning, try to get outside into daylight for your exercise, even if this is just a quick walk round the block
• If you’re doing exercise, remember little and often is better than an occasional full-on two-hour workout. Go gently at the start, eat and drink to maintain blood glucose levels and hydration, and stretch out gently afterwards
• Make sure you are eating regularly every three to four hours. Consider introducing a bedtime snack, especially if you eat your main meal in the early evening. Think about the balance between the food groups and try to reduce carbohydrates like sugar, cakes, biscuits, fizzy drinks, potatoes, rice, and wheat products such as bread, pasta and pizza. Compared to carbs, increase the proportion of protein in your diet by altering the relative portion sizes. You can also try increasing the proportion of fats relative to carbs, though fats can also sometimes cause problems for those with migraine. Increase the quantity of vegetables you eat too – you can’t have too many! Snacks of nuts, seeds, berries and dairy products may be useful too.
• Mindfulness and breathing exercises can help. Slow exhalations, yoga stretches and other techniques like expressive writing, gratitude journaling and meditation can all help reduce anxiety and improve restorative sleep quality.
• Beware of caffeine and alcohol. It’s tempting to use these to relieve our stress or perk us up, but both are unhelpful for sleep quality and can trigger migraine attacks.
• Be sure to have a good supply of the usual medications that you take to help your acute migraine and also your preventative medications if applicable. GP surgeries and healthcare services may be less accessible during Covid infection peaks but they’re still open, although they operate via video consultations or telephone.
• If you have not tried them already, it may be worth trying supplements which have some evidence of benefit in reducing migraine: magnesium, riboflavin (vitamin B2) and co-enzyme Q10. See our factsheet on ‘natural’ remedies for more information.
• Avoid reading, watching or listening to depressing or anxiety-provoking news stories, which can often circulate widely on social media too. Find a trusted news source and only update yourself once a day – preferably not just before going to bed. It is very easy to catastrophise and that will raise stress hormone levels, which in turn can make migraine more likely.
• Get in touch with the National Migraine Centre for an appointment with a headache specialist doctors, to give you a personal plan to reduce the impact of your migraine. We operate remote consultations so you can see an expert headache specialist even during a lockdown.

Does the Covid vaccination cause migraine?

Side effects from vaccination are usually mild and short-lived. They may include headache and some people have reported a worsening of migraine symptoms. However, there is no evidence that the vaccination is unsafe for those with migraine.

There have been reports of an extremely rare but serious condition involving blood clots in the brain, which can involve prolonged headache and other neurological symptoms. Around 30 per cent of these cases occurred in those aged under 30. However, the risk is still very low, and, in the case of the AstraZeneca vaccine, is estimated to affect fewer than 40 people for every million vaccinated.

Protecting yourself from a potentially more severe Covid infection has other important health benefits. But it’s worth considering that a Covid infection will often cause headache and a worsening of migraine symptoms that could last much longer than the usually short-term side effects of vaccination.

Medication to avoid if you have a Covid-19 infection

There has been some discussion about the use of aspirin, ibuprofen, naproxen and other painkillers that are categorised as NSAIDs during a Covid-19 infection.

Early in the pandemic, there were concerns that these drugs, and ibuprofen in particular, could worsen a Covid-19 infection. However, the NHS now points out that the Commission on Human Medicines has confirmed there is no clear evidence that using ibuprofen to treat symptoms such as a high temperature makes coronavirus worse.

Out of caution, if you have symptoms of the virus and need to take a painkiller for headache, we recommend paracetamol. The headache the virus causes may be different from your usual migraine, but it does seem to respond to paracetamol, which will also help to control high temperatures.

Codeine, alone or in combination products such as co-codamol and Migraleve, and opiates, such tramadol, are always best avoided by people with migraine.

It is considered safe to take triptan medication and your usual preventative treatments.

The impact of lockdowns: finding alternatives to your usual treatments

When GP surgeries and other healthcare services are closed to face-to-face consultations, some treatments for headache may be unavailable. During the initial lockdowns, this largely affected people who needed Botox treatment and greater occipital nerve blocks.

There are various preventative options that can be accessed even through remote consultations, including medications, neuro-modulation devices (such as Cefaly Dual and sTMS mini) and anti-CGRP injection prescriptions. Book an appointment at the National Migraine Centre to find out more.

To find out more about Covid-19 and migraine, listen to our podcast episode 9 in series 2 on the topic.

Find out more

Book an appointment with the experts: review the best treatment options for you with a leading headache specialist. Beat the misery of migraine and get back to living. Book your consultation through the National Migraine Centre now.