Migraine is one of the most common neurological disorders that should be addressed in all hospitals worldwide in OPD clinics.
Normally Migraine is triggered by the following reasons:
Lack of sleep
Skip of meals
Bright lights, loud noises, or strong odours
Hormone variation during the menstrual cycle
Stress and anxiety, or relaxation post-stress
Often intake of alcohol like red wine
Consumption of too much caffeine
Foods that have nitrates like hot dogs and lunch meats
Foods that have MSG (monosodium glutamate) which is a flavour enhancer that is found in fast foods, broths, seasonings, and spices.
Foods that have tyramine like aged cheeses, soy products, smoked fish, Chianti wine, fava beans and hard sausages.
Migraine in the time of COVID-19 is a new challenge, the fear of this illness itself is enough for many of the known migraine patients to have an attack. At the same time, many patients may experience a new onset headache which may be migraine or stress-related headaches precipitated by COVID-19.
As most people were locked in, their eating and sleeping habits might have become erratic, which may be an important trigger to get more severe and prolonged migraine issues.
The challenge which we face is the reluctance to approach a hospital to receive treatment as the fear of COVID-19 is all-pervasive.
Patients who are already associated with migraine can be managed through teleconsultations. Meanwhile, a large number of new headaches patients may be consulted if they have their first consultation over the telemedicine medium if their symptoms need further intervention they may be requested to visit the nearest Neurological center for better management.
The next question which arises is regarding the treatment of a patient who is having a migraine attack. There was a lot of discussion regarding the NSAIDs, the primary drug used in the treatment for migraine rescue therapy. It was postulated that it may affect macrophage function by decreasing ACE levels similar to what was proposed with ACE inhibitors.
Recommendations may change further as our understanding of COVID-19 evolves. Clinicians should consider these differing viewpoints, the most current guidelines and recommendations, and the needs of their patients when deciding to use rescue drugs.
Another important point to note is to make sure the patient is not taking too many medicines which can cause long QT such as neuroleptics (Prochlorperazine)
These drugs can prolong QT on their own hence caution must be advised when they are being given along with hydroxychloroquine.
The next treatment of concern is with regards to treatment with Onabulotoxin A, this entails close contact with the patient’s head and neck region and it should only be reserved in intractable cases/ failure of other drug regimens.
The CDC recommends taking measures to reduce stress and anxiety during these times, such as:
Take breaks from news stories and social media feeds about COVID-19
Do breathing exercises or meditation practices
Avoid alcohol and drugs
Contact friends or family members to discuss feelings
To conclude, migraine is a fairly common problem that may be triggered by stress related to the ongoing pandemic. The patients can take over the counter medications and can consult the Best Neurologist in Bangalore by the telemedicine medium/ in person. Stress which is as stated above should be avoided to prevent excessive drug use.