Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross- sectional study

DOI: https://doi.org/10.1186/s10194- 021- 01263- 1

Abstract-Summary To assess the impacts of social situation changes due to the coronavirus disease 2019 (COVID-19) pandemic on headache-related disability and other symptoms in patients with migraine in Japan.

The participants were asked about the impacts of the first wave of the COVID-19 pandemic on headache-related disability, headache days, headache intensity, stress, physical activity, hospital access and their work and home lives.

Multivariate stepwise linear regression analysis was performed to identify the clinical predictors of changes in the total MIDAS score before and during the COVID-19 pandemic.

Logistic regression analysis was performed to determine the factors related to

new-onset headache during the COVID-19 pandemic.

The total MIDAS and A and B scores did not significantly change after the first

wave of the COVID-19 pandemic.

The multivariate stepwise linear regression analysis of changes in the total MIDAS score before and during the first wave of COVID-19 pandemic identified worsened sleep, increased acute medication use, increased stress, medication shortages, comor- bidities, the absence of an aura and new-onset headache were determinants of an increased total MIDAS score during the first wave of the COVID-19 pandemic.

In this multicentre study, clinical factors relevant to headache-related disability, such as new-onset headache, stress and sleep disturbances, were identified, high- lighting the importance of symptom management in migraine patients during the first wave of the COVID-19 pandemic.

Extended: The participants were asked about the impacts of the first wave of the COVID-19 pandemic on stress, physical activity and their work and home lives

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5 Future Directions

(frontline worker, switching from working outside the home to working at home, and occupation) and if they had received prescriptions for medications via a tele- phone or online consultation.

The total MIDAS score and part A and B scores [309] were used to compare the degree of disability experienced in daily life related to the presence of headache, headache days and headache intensity during the 3 months before and after the first declaration of the state of emergency in April 2020.

In this multicentre study, we studied the effects of social distancing during the first wave of the COVID-19 pandemic on headache-related disability, daily life and other various clinical symptoms using clinical information, headache diaries, and questionnaires at multiple headache centres.

Introduction In Japan, the infection began to spread in late February 2020, and in April, during the first wave of the COVID-19 pandemic, the first nationwide state of emergency declaration was issued, requesting people to refrain from leaving their homes to prevent the further spread of COVID-19.

A study from Spain, which investigated the psychological effects of the COVID-19 pandemic in 976 adults, found increases in anxiety, stress, and depres- sion after the nationwide state of alert was issued [310].

It is likely that increased stress during the COVID-19 pandemic affects migraine. The impacts of changes in social situations during the COVID-19 pandemic on

migraine have not yet been addressed.

We designed a multicentre, cross-sectional study to investigate the effects of the first wave of the COVID-19 pandemic on headache-related disability and other clin- ical symptoms in migraine patients in Japan.

Methods Based on the mean (14.7) and SD (18.7) of the total Migraine Disability Assessment (MIDAS) score in 161 migraine patients [311], the difference in the MIDAS score due to the impact of the COVID-19 pandemic was assumed to be 2.0.

Participants’ interest in and concern about COVID-19 and new-onset headache

during the first wave of the COVID-19 pandemic were assessed.

New-onset headache was defined as being present if the patients reported that they had developed a headache that was different in nature and intensity from their usual migraines after the declaration of the state of emergency.

The Wilcoxon signed-rank test was used to compare the total MIDAS score and part A and B scores before and during the COVID-19 pandemic, as the differences between pairs of data were non-normally distributed according to the Kolmogorov- Smirnov test.

Results Problems accessing the hospital were reported by 15.7% of the participants, and a headache medication shortage was reported by only 7.1% of the participants.

During the COVID-19 pandemic, 15.7% of the participants received online med- ical care; the advantages included infection risk reduction, which was reported by the majority (95.8%) of patients, and the ability to continue working, which was reported by 23.2%.

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COVID-19 and SARS-COV2 Vaccines

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Patients with new-onset headache had a higher rate of aura, greater impact of COVID-19 on their daily lives, higher rate of medication shortage, greater concerns about COVID-19, higher stress levels, worsened mood and sleep, and a higher rate of mask usage (h/d) than patients without new-onset headache.

Out of the 606 patients, 446 patients (73.6%) reported their headache days on the

MIDAS based on their headache diaries.

Discussion We found that 56.8 % of the patients with migraine reported increased stress, and increased stress was one of determinants of the development of new-onset head- aches during the first wave of the COVID-19 pandemic.

According to the stepwise linear regression analysis, among the many clinical and social characteristics of patients with migraine, the worsening of sleep, increased use of acute medications, increased stress, medication shortages, the presence of comorbidities, the absence of aura and new-onset headache were significant con- tributors to increased headache-related disability during the first wave of the COVID-19 pandemic.

Other studies addressed changes in headache intensity or migraine days during the COVID-19 pandemic [250], but changes in disability related to headache in patients with migraine have not been well studied.

Our study identified several clinical factors contributing to headache-related dis- ability and helped clarify the changes in clinical symptoms in migraine patients during the COVID-19 pandemic, which may contribute to improving the future management of migraine patients.

Acknowledgement A machine generated summary based on the work of Suzuki, Keisuke; Takeshima, Takao; Igarashi, Hisaka; Imai, Noboru; Danno, Daisuke; Yamamoto, Toshimasa; Nagata, Eiichiro; Haruyama, Yasuo; Mitsufuji, Takashi; Suzuki, Shiho; Ito, Yasuo; Shibata, Mamoru; Kowa, Hisanori; Kikui, Shoji; Shiina, Tomohiko; Okamura, Madoka; Tatsumoto, Muneto; Hirata, Koichi 2021  in The Journal of Headache and Pain.

Overall trend towards headache remission during the COVID-19 pandemic among Chinese patients with pre-existing headache highlights the role of family support