How Does Quarantine Impact Migraineurs?

A survey conducted among migraineurs in Genova, Italy, found that during the coronavirus disease 2019 (COVID-19) quarantine, patients experienced fewer migraine attacks and less pain but exhibited moderate levels of depression correlated to migraine burden. The findings were published in Neurological Sciences.

Italy was one of the earliest countries to experience widespread public disruptions and hospitalizations due to COVID-19. On February 23, small towns hit by the outbreak were first put under quarantine, and on March 10, the entire nation was placed on lockdown. Travel bans and mandatory stay-at-home orders were enforced through May 3.

Researchers point out that quarantine is a well-known risk factor for psychological and psychiatric disturbances. To assess the impact of lockdown on migraine in terms of migraine burden, and on associated anxiety and depressive symptoms, participants recruited from a headache clinic completed a series of surveys and evaluations.

Between January 1 and March 9, 2020, a retrospective consecutive cohort of patients admitted to a headache clinic was recruited to the study. Only those completing follow-up visits were considered for the study. In total, 49 individuals were included, 79.59% of whom were female, with a mean (SD) age of 46.24 (15.04) years. In addition, 20.4% of the cohort exhibited migraine with aura.

All participants underwent telephonic clinical evaluations, personal interviews, and evaluation of migraine severity via the Global Assessment of Migraine Severity (GAMS) and Visual Analogue Scale (VAS). Depression and anxiety were measured by the Beck depression inventory (BDI) and Zung Self-Rating Anxiety Scale (SAS), respectively.

“Paired sample t test was performed to evaluate the changes in the value of migraine score from the 2 months immediately before lockdown (from January 1st to March 9th) to the 2 months of quarantine (from March 10th to May 3rd),” the authors wrote.

The study yielded the following results:

• Mean (SD) GAMS value was 5.61&thinsp;(0.76) before and 4.16&thinsp;(1.46) during quarantine (P&thinsp;<&thinsp;.001)
• Mean (SD) VAS was 7.49&thinsp;(1.10) before and 5.47&thinsp;(1.88) during quarantine (P&thinsp;<&thinsp;.001)
• Frequency of triptan utilization for migraine attacks (mean [SD] number pills/week) was 2.84 (2.54) in the period before as opposed to 2.00&thinsp;(1.78) during quarantine (P&thinsp;=&thinsp;.041)
• Mean (SD) value of Beck and Zung scales were 13.10&thinsp;(7.33) and 22.71&thinsp;(13.36), respectively, indicating the presence of a mild to moderate level of depression and normal to mild level of anxiety during quarantine
• Mixed analyses of variance on migraine severity, measured both with GAMS and VAS, showed a main effect on time of F(1,47)&thinsp;=&thinsp;12.45 (P&thinsp;=&thinsp;.001) and F(1,47)&thinsp;=&thinsp;18.87 (P&thinsp;<&thinsp;.001), respectively, indicating an amelioration of migraine symptoms
• Time by depression level interaction, F(1,47)&thinsp;=&thinsp;6.21 (P&thinsp;=&thinsp;.016) and F(1,47)&thinsp;=&thinsp;14.52 (P&thinsp;<&thinsp;.006), respectively, showed that subjects with lower level of depression had better course of migraine

Although the analysis found mild to moderate levels of depression and mild levels of anxiety during the 2-month period of quarantine, due to lack of data, researchers were unable to compare the information with the period before lockdown.

Authors hypothesized that the prolonged period of time spent at home may have reduced outside stressors coming from work and social activity, thus reducing triggers of migraine attacks. Furthermore, presence of anxiety and depression could be related to the specific cause of lockdown: the COVID-19 pandemic. However, data did show “an interaction between depression and migraine burden, with better course of migraine in less depressed subjects.”

The retrospective design and lack of data on psychiatric comorbidities prior to quarantine pose limitations to the study, along with a relatively small sample size. The findings may not be generalizable to the wider population with migraine.

Reference

Parodi IC, Poeta MG, Assini A, et al. Impact of quarantine due to COVID infection on migraine: a survey in Genova, Italy. Neurol Sci. Published online July 1, 2020. doi:10.1007/s10072-020-04543-x