Life in a global pandemic seems like one big recipe for a headache. Anxiety and stress are major trigger factors for migraine attacks, and the continuing impact of Covid-19 has presented plenty of both. So for the specialists at the Jefferson Headache Center, one surprising finding stands out: While many of their migraine patients’ headaches have indeed worsened since the start of the Covid-19 crisis, roughly half have actually improved.
“I’d say it’s fifty-fifty. Half are doing worse, half are doing better,” says Jefferson Headache Center’s Dr. Simy Parikh. “And since there are so many aggravating factors for migraine right now, it’s been interesting to see so many people doing well.”
What separates the people who are struggling from those who are thriving? Doctors say the critical difference lies not in biology, but in behavior — that the people who are improving despite the pandemic are those who have been able to stick with their prevention routines, and in some cases, even enhance those routines. Their surprise success underscores the crucial importance of lifestyle in migraine management and holds valuable lessons for people with headache and migraine.
Why Some People Are Doing Worse
Some people’s migraine health has been thrown off-kilter after losing jobs and health insurance, which meant interruptions in treatment. Others have been destabilized after contracting Covid-19, which has lingering health effects. But doctors say the most common factors they’ve seen by far are a double whammy of stressors: the chronic stress of life in lockdown mode, compounded by the eroding of people’s migraine-healthy behaviors and routines.
It’s perfectly understandable that as the rhythms of normal life collapsed, so too did people’s habits meant to build their migraine thresholds, says Parikh. “It can be hard to maintain healthy routines, even in ideal times,” she says. “Unfortunately, times of major change is when people need these things the most.”
Patients with worse migraine health have reported these common threads:
- Too much screen time. All that light pouring into our eyes can bring on a headache and, if too close to bedtime, also interferes with good-quality sleep (a crucial protective factor for migraine). In addition, hunching for hours over computers and phones creates neck tension that leads to head pain.
- Fewer boundaries between work and home. When your home is also your office – and, perhaps, your daycare, fitness studio, kids’ classroom, 24-hour diner, and your date night — some people have found it impossible to create the healthy separation that once allowed them to relax, leaving them chronically anxious.
- Lack of exercise. When gyms closed their doors, many people lost their reliable source of stress relief. Plus, with people spending less time out and about in general, inactivity increased.
- Inconsistent sleep routines. “Too little sleep, too much sleep, people’s sleep patterns have really shifted,” says Dr. Parikh.
Thriving During the Pandemic
Amazingly enough, the very start of the pandemic witnessed a brief burst of migraine wellness in just about everyone who began working from home, says Jefferson Headache Center’s Dr. Michael Marmura. “Early on, most people were doing okay, and some people would say they were actually doing better,” he remembers. A key factor was the sudden absence of workplace stressors like fluorescent lighting, sounds and smells, or the difficulties of the commute. In addition, people gained the ability to lie down at the first sign of migraine symptoms, rather than “power through” a workday attack.
For some patients, though, shedding those extra stressors was just the first step. With the help of their more flexible work-from-home schedules — often taking advantage of the time they’d otherwise be commuting — they took the time for migraine-beneficial activities. The activities themselves have run the gamut, from exercise, sleep, eating, hydration, mental health to meditation – it hasn’t seemed to matter, as long as the patient has been doing something proactive.
“The patients who are doing well have taken it as an opportunity for more control,” explains Marmura. He adds that some have been so encouraged by their successes that they’ve been able to go a step further: “Not only have they continued their routines, but some have said ‘I’m going to pick up something new.’” For example, a patient who bikes for exercise is also dabbling in online yoga; people new to meditation have added a ten-minute morning practice; others have created end-of-day routines of an outdoor walk and stretching session, which doubles as post-work decompression time.
Strategies for Migraine During Covid-19
If you’re one of the millions of people for whom the pandemic has made migraine worse, there is hope. It’s also important to note that not everyone right now has the luxury of time and flexibility to create or sustain migraine-healthy behaviors — in particular, essential workers and those without much social support. But whatever your situation, there are proactive things you can do right now to help yourself thrive with migraine.
- Know your migraine. Every person’s migraine is different. Being aware of your stressors and symptoms makes you better equipped to take care of yourself.
- Ask for help. To make time to care for yourself, reach out to your network of supportive friends and family, then make specific requests of them.
- Get proper sleep, nutrition and hydration. These are the foundational elements of your core health. Addressing even one of them will make a difference.
- Move your body. Exercise is crucial to raising your threshold for migraine.
- Get routine healthcare. Covid-19 has made many people hesitant to visit a doctor. But managing any other health conditions you may have is an important part of managing migraine.
- Use telemedicine. Most restrictions on telemedicine have been dropped so that you don’t need to leave home to see a doctor, even if they’re in another state. Use this time for a check-in with your headache doctor. “Most doctors are doing this. Don’t be shy about asking for what you need,” adds Marmura.
- Seek psychological support. Talk therapy helps reduce stress and is highly effective in treating migraine, reducing headaches up to 67%.
- Show yourself compassion. No one ever said this was easy. Wherever you are with migraine right now, and whatever you’re able to do, give yourself credit. Find a way to tell yourself every day, I’m proud of myself for doing the very best that I can.
For more in our Covid-19 and Migraine series, read “Bad Posture and Migraine: Your Work-From-Home Ergonomic Tune-Up.”