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

DOI: https://doi.org/10.1186/s12883- 021- 02216- 6

Abstract-Summary The present study aimed to investigate the impact of the COVID-19 pandemic on headache patients in China.

Demographic characteristics, the PHQ-9, the ISI, a COVID-19 questionnaire and

a headache profile survey were included in the online questionnaire.

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Two thousand eight hundred and six participants had pre-existing headache

disorders.

Our analysis showed reductions in the duration of headaches (3.414 ± 6.859 vs. 4.033 ± 7.325 h, P < 0.001), number of headache days per month (1.788 ± 2.989 vs. 2.092 ± 3.694, P < 0.001), and headache intensity (4.110 ± 1.609 vs. 4.290 ± 1.680, P < 0.001) during the COVID-19 pandemic.

Smoking (OR = 1.397, 95% CI 1.090–1.790, P = 0.008) and getting support from family members during social isolation (OR  =  1.656, 95% CI 1.075–2.550, P  =  0.022) were independent factors affecting the reduction in the duration of headaches.

Education level (OR = 1.478, 95% CI 1.103–1.980, P = 0.009) and having a rela- tive or acquaintance who contracted COVID-19 (OR = 0.643, 95% CI 0.458–0.902, P = 0.011) were the independent factors affecting the reduction in headache severity. Participants experienced an overall trend towards the improvement of headaches

during the COVID-19 pandemic.

Extended: Our analysis showed reductions in the duration of headache, number of headache days per month, and headache intensity during the COVID-19 pandemic.

Our analysis showed that the ISI scores were significantly lower in the remission

group than in the aggravation group.

Background Headache is an important neurological symptom reported in COVID-19 patients [213].

Almost 11–34% of hospitalized COVID-19 patients present with headache [246]. The COVID-19 outbreak has drastically affected the medical care received by

patients with pre-existing headache disorders [312].

It is imperative to understand the present status of headache patients during the

COVID-19 pandemic.

No research has been reported on headache patients in China during the

COVID-19 pandemic.

The present study was performed to investigate the impact of the COVID-19 pandemic on headache patients in China and to further explore potential factors aggravating or relieving their headaches.

Methods Participants who competed all the items on the online questionnaire were included. The headache profile section included items on a history of pre-existing head- ache disorders, the characteristics of the accompanying symptoms (nausea, vomit- ing, photophobia, phonophobia and osmophobia, aggravation by or causing avoidance of routine physical activity, lacrimation, rhinorrhoea, conjunctival injec- tion, eye bilges and remission induced by massage), headache triggers (increased stress, short sleep duration, excessive sleep, menstruation, bright light, noise or spe- cial smell, special foods and alcohol), headache intensity, headache days per month, headache duration at baseline and during the COVID-19 pandemic, and factors

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COVID-19 and SARS-COV2 Vaccines

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associated with headache during the COVID-19 pandemic (stress, sleep quality, changes in lifestyles and decreased social interaction).

Participants who reported decreases in headache frequency, headache severity or headache duration were included in the remission group; those who reported no changes were included in the unchanged group; those who reported increases were included in the aggravation group.

Results The aggravation group had significantly higher proportions of participants who smoked, lived in the Wuhan area, had a relative or acquaintance who contracted COVID-19, and received less support from family members during social isolation and had significantly higher ISI, PHQ-9 and ISE-R scores than the remission group (P < 0.001, P = 0.009, P = 0.002, P < 0.001, P < 0.001, P < 0.001, P < 0.001, respec- tively) and the unchanged group (P  =  0.005, P  =  0.008, P  =  0.002, P  =  0.005, P < 0.001, P < 0.001, P < 0.001, respectively).

The aggravation group had a significantly higher proportion of participants who had relatives or acquaintances who had contracted COVID-19 than the remission group (P < 0.001) and the unchanged group (P < 0.001).

Discussion The present study is the first to investigate the impact of the COVID-19 pandemic on headache patients in China.

Smoking, education level and receiving support from family members during social isolation were independent factors affecting the remission of headaches dur- ing the COVID-19 pandemic.

Participants living in the Wuhan area, having COVID-19 symptoms or a diagno- sis of COVID-19 and having relatives or acquaintances with COVID-19 were more likely to experience the worsening of their headaches.

A previous study showed that migraine patients from the Italian National Headache Registry showed a mild improvement in migraine characteristics during the COVID-19 pandemic [251].

Participants who lived in the Wuhan area, had COVID-19 symptoms or a diagno- sis of COVID-19 and had relatives or acquaintances who contracted COVID-19 were more likely to experience a deterioration in their pre-existing headache disorder.

Further study is needed to determine the impact of COVID-19 on headache

attacks.

Conclusion The present study provides the first data about the impact of the COVID-19 pan- demic on headache patients in China.

The adverse impacts of COVID-19-related events on headache patients, espe- cially those living in high-risk areas, should not be overlooked, although there was an overall trend towards headache remission during the COVID-19 pandemic.

We call for more family support to help headache patients improve or eliminate

headache attacks.

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Acknowledgement A machine generated summary based on the work of Gong, Qiaoyu; Liu, Shuping; Li, Ruiting; Yao, Lihua; Xiao, Zheman 2021 in BMC Neurology.

Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown