The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study

DOI: https://doi.org/10.1186/s10194- 021- 01256- 0

Abstract-Summary Coronavirus disease 2019 (COVID-19) bring about a range of psychological dis- tress and symptom deterioration to headache patients especially to some migraineurs. Compared to migraineurs or normal control, medication overuse headache (MOH) patients are more likely to experience a worse psychological distress and poorer outcome in non-COVID-19 time.

In COVID-19 pandemic, whether MOH patients would have greater physical and mental symptom deterioration or worse relief of headache symptoms and medi- cations overuse remained unclear.

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To pre-pandemic period, fewer MOH patients reported decreased headache days,

intensity and days with acute medications per month during the pandemic.

Available access to regular prophylactic medications was significantly associated with a reduction of at least 50% in headache days and decrease in headache inten- sity per month with respective odds ratios of 39.19 (95% CI 3.75–409.15, P = 0.002) and 10.13 (95% CI 2.33–44.12, P = 0.002).

Male sex was significantly associated with decrease in days with acute medica- tion per month during the pandemic (odds ratios 4.78, 95% CI 1.44–15.87, P = 0.011).

Our findings reflect that MOH patients experienced a worse relief of headache

symptoms and drug withdrawal during the pandemic.

Available access to regular prophylactic medications was the significant inde-

pendent factor for improvement of headache symptoms.

Male sex was significantly associated with decreased days with acute medica-

tions per month.

Extended: Coronavirus disease 2019 (COVID-19) caused by severe acute respi- ratory syndrome coronavirus 2 (SARS-CoV-2) [283] has already rapidly spread around the world as a pandemic after its first report in Wuhan, China on December 12th 2019 [284–287].

Available access to regular prophylactic medications only occurred in 41.0%

(32/78) patients during the pandemic.

Available access to regular prophylactic medications was significantly associated with the reduction of at least 50% in headache days and decreased headache inten- sity per month during the pandemic.

Available access to regular prophylactic medications was the significant inde-

pendent factor for improvement of headache symptoms.

Male sex was significantly associated with decrease in days with acute medica-

tion per month.

Introduction For patients with chronic neurological diseases, such as multiple sclerosis, neurode- generative disease, chronic headache and etc., they were considered to probably experience psychological distress such as despair or depression under the impact of the COVID-19 pandemic as Bhaskar stated, which resulted in non-compliance, potential relapse and worsening of the condition [288].

Like the phenomenon we observe under non-COVID-19 circumstances, we con- sidered that MOH patients might be inclined to experience a greater symptom dete- rioration or worse relief of the condition than migraineurs did under the impact of the COVID-19 pandemic.

In this cross-sectional study, we aimed to investigate the change and relevant fac- tors of headache days, headache intensity, and days with acute medication per month in MOH patients during the COVID-19 pandemic, compared by those in pre-pandemic period, to provide guides for the management of MOH patients dur- ing the time attacked by this public health emergency.

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COVID-19 and SARS-COV2 Vaccines

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Methods and Materials The following items were included in the questionnaire: (1) Demographic variables (sex, age, marital status, living with others, educational level, and household income monthly). (2) MOH related information of pre-pandemic 3 months period and COVID-19 pandemic period (preexisting headache, duration of medication overuse, available access to regular prophylactic medications, headache days per month, headache intensity [Visual Analogue Scale score with range of 0–10] per month, days per month with acute medication, and Migraine Disability Assessment Scale [MIDAS] score). (3) COVID-19 related information (epidemiological area expo- sure history, suspected COVID-19 cases themselves or in their relatives, COVID-19 cases in respondent’s residential community, feel of difficulty in controlling emo- tions, frequency of COVID-19 related dreams, duration per day spent on following news of COVID-19 pandemic, level of concern about the pandemic [4 points scales from “relatively unconcerned or very unconcerned” to “very concerned”], psycho- logical disorder history, psychological distress during the COVID-19 pandemic [Mandarin version of Kessler 6-item psychological distress scale (K-6 scale) [289]], and COVID-19 related stressor investigation scale).

Results Seventy-eight MOH patients (70.9%) were enrolled.

Available access to regular prophylactic medications only occurred in 41.0%

(32/78) patients during the pandemic.

The duration spent on following COVID-19 pandemic news was also low with mean of 0.6 (±1.1) hours per day, and more than half of the patients were relatively unconcerned or very unconcerned about the pandemic.

On basis of the stressor scale, MOH patients were found to be affected, to a minor degree, by multiple COVID-19 related aspects excluding the item of COVID-19 death.

Compared to pre-pandemic period, headache days per month unchanged in more than half of patients (53.8%), and increased in 16.7% (13/78) of patients during the pandemic.

With regard to the headache intensity per month, 8 (10.3%) patients reported increased headache intensity and 43 (55.1%) patients remained unchanged during the pandemic.

Discussion We conducted this study to investigate the change in headache days, headache intensity, days with acute medication per month and their relevant factors among MOH patients from 3 months pre-pandemic to COVID-19 pandemic for a better management.

These results differ from the findings of several published studies conducted in MOH patients under non-COVID-19 condition [290–293], which found significant decrease in headache days and intensity per month in most MOH patients with regu- lar prophylactic medications.

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The results showed that as the fact in non-COVID-19 time [290, 292, 294] com- bined therapy of abrupt withdrawal with prophylactic medications could also decrease headache days and headache intensity per month in MOH patients during the COVID-19 pandemic.

Some MOH patients with frequent headache attacks might be less willing to fol- low the abrupt withdrawal approach as they did in non-COVID-19 time [295] and still remained medication overuse especially when they did not receive regular pro- phylactic medications during the pandemic.

Conclusions Our findings reflect that MOH patients experienced a worse relief of headache symptoms and drug withdrawal during the pandemic.

Available access to regular prophylactic medications was the significant inde-

pendent factor for improvement of headache symptoms.

Following abrupt withdrawal and high educational level were both significant

factors for decreased headache intensity.

Acknowledgement A machine generated summary based on the work of Li, Changling; Li, Yanbo; Ma, Mengmeng; Zhang, Yang; Bao, Jiajia; Ge, Wenjing; Liu, Yanqin; Peng, Cheng; He, Li 2021 in The Journal of Headache and Pain.

The status and high risk factors of severe psychological distress in migraine patients during nCOV-2019 outbreak in Southwest China: a cross-sectional study