Chronic migraine in the first COVID-19 lockdown: the impact of sleep, remote working, and other life/psychological changes

DOI: https://doi.org/10.1007/s10072- 021- 05521- 7

Abstract-Summary The objective of this study was to evaluate the impact of the first Italian COVID-19 lockdown on patients with chronic migraine (CM).

The survey evaluated demographic, life style, sleep, psychological, and migraine

features during the COVID-19 lockdown period and the month before.

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The outcomes were migraine impact on daily life and variation in attack fre- quency, attack duration, migraine pain intensity, migraine symptomatic drugs use per week, and efficacy.

During the lockdown period, attack frequency was stable in 40.2%, increased in 33.7%, and reduced in 26.1% of patients; attack duration was stable in 55.4%, increased in 23.9%, and reduced in 20.7%.

Migraine pain was stable or reduced in 65.2% and increased in 34.8%; number of symptomatic drugs per week was stable in 50%, reduced in 29.3%, and increased in 20.7%; migraine drug efficacy was stable in 73.9%, reduced in 17.4%, and increased in 8.7%.

Extended: Using COVID-19 lockdown as a unique occasion to acquire new insights into this disease, the study evaluated the influence of social habit, family life, work life, mood, SQ, perceived stress, and future concern on CM patients.

Introduction Lockdown represented a revolution for life of many people, it was a stressful condi- tion which forced Italians to stay at home limiting human contact, changing the way to live relations and to work in the context of a pandemic which threatened public health and devastated economy.

The aim of the present study was to evaluate the influence of the first COVID-19

lockdown in Italy on CM patients.

We investigated the impact of CM on daily life during the lockdown and changes in frequency, attack duration, pain intensity, and drugs between this period and the previous month.

Using COVID-19 lockdown as a unique occasion to acquire new insights into this disease, the study evaluated the influence of social habit, family life, work life, mood, SQ, perceived stress, and future concern on CM patients.

Methods Migraine module evaluated migraine familiarity, anti-migraine drug overuse story, migraine with aura, age of onset, age of migraine chronification, variation of migraine frequency (increased, reduced, or a stable number of migraine days per month compared to pre-lockdown period), variation of migraine attack duration (increase, reduction, or no change compared to pre-lockdown period), increased migraine pain intensity during lockdown, variation of migraine symptomatic drugs use per week (increase, reduction, unchanged in comparison with previous period), variation of migraine drug efficacy (increase, reduction, unchanged compared to previous period), the six-item headache impact test (HIT-6, provides a global mea- sure of adverse headache impact, the score ranges from 36 to 78, a higher score is associated with a worst condition).

Results Age of migraine onset was ≤18 years in 66.3%.

Migraine became chronic at an age ≤18 years in 27.2%, between 18 and 30 years

in 41.3%, and at an age ≥31 years in 31.5%.

An anti-migraine drug overuse story was present in 80.4%.

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Influences of Demographics, Life Style, Sleep, Psychological, and Migraine Features on Migraine Outcome An increased migraine attack duration was associated with a reduction in meal regu- larity, reduced sleep time duration, reduced quality of sleep, increased sleep latency, worsening in perceived depression/anxiety, a higher PSS score, and increased per- ceived stress.

Concern for the future, reduced sleep time duration, no migraine familiarity, increased perceived stress, and higher STAI-T score remained significant on multi- variate analysis.

A reduction of migraine drug efficacy was associated with smoke, increased sleep latency, worsening in perceived depression/anxiety, increased perceived stress, higher STAI-S score, and concern for COVID-19.

Multivariate analysis showed that the efficacy reduction was associated with smoke, STAI-S, and concern for COVID-19 and that the improvement was related with remote working and improved quality of sleep.

Discussion Migraine severity and changes in lockdown were associated with several elements: some classical migraine-related factors and others that were never reported in literature.

Around life style, our smoker patients showed an increased migraine attack fre-

quency and a reduction of migraine drug efficacy.

Regarding sleep, the present study showed that a reduced sleep time duration

was related with an increment in migraine attack duration and pain.

Familial predisposition plays an important role in migraine: it was linked with an

increased migraine risk and a higher attack frequency in other studies [269].

An interesting finding is that RW was associated with reduced migraine attack

duration and increased drug efficacy.

The other studies associated migraine changes with sleep disturbance, depres- sion, anxiety, emotional reaction, pandemic risk perception, computer use, eating habits, and physical activity during lockdown [218, 250–275].

Conclusion Our study represented a unique prospective to observe and evaluate CM in different conditions from daily routine.

Differently than other studies, we focused on CM patients, the migraineurs who

are frailest and the most difficult to treat.

Anxiety, stress, and sleep problems represent an enormous burden for CM that negatively influence their life and would be always investigated and treated in col- laboration with different professional figures.

Acknowledgement A machine generated summary based on the work of Currò, Carmelo Tiberio; Ciacciarelli, Antonio; Vitale, Chiara; Vinci, Enrica Serena; Toscano, Antonio; Vita, Giuseppe; Trimarchi, Giuseppe; Silvestri, Rosalia; Autunno, Massimo 2021  in Neurological Sciences.

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Characterization of Headache in COVID-19: a Retrospective Multicenter Study