Migraine is a common disorder that affects three times more women than men. It is also observed that people with migraine and other headache disorders are often unsure of their condition and tend to ignore it until it becomes chronic or life threatening. More than 80% of people self diagnose this condition, fearing stigma and believing in this ideology, ‘its just a headache and it shall pass’!
At this backdrop, it becomes essential to understand how headaches and migraines can have a lasting impact when left untreated on time. Let’s look at a few common questions answered by our neurology expert, that are likely to increase awareness amongst patients suffering from these conditions, particularly during the COVID-19 pandemic. Not only for patients but this summary can be of help to caregivers and society alike.
Q1. How has care for patients with chronic headache or migraine changed during COVID-19 pandemic?
We have seen a fairly broad picture for the manifestation of these conditions during the pandemic. With drastic lifestyle changes, lack of social connect, high burnout and a dented routine, the impact can be categorized into two segments. The first being, people who are inconsistent with their diet schedules or have irregular sleep patterns. The second being, people who were ideal at home and gaping at their TV sets, binging Netflix and similar for hours at a stretch. Now both scenarios may have intensified during the lockdown and the pandemic fear. Long hours looking at a television, computers, tablets, cell phones, and video games can lead to exhaustion, lack of circulation, and eyestrain, which may have enhanced the underlying headaches and in some severe cases moved to a migraine. Although, the ‘home setup’ and the acceptance of the same has also helped people to eventually get regimental and manage themselves better. So the care aspect here honestly has been more on self-correction. The second category may not be that fortunate! Late nights sleep disorders and other conditions have ended up aiding and increasing cases of headaches/migraine and here comes the role of doctors for mitigating the conditions through examination and medications if approached by patients on time.
Q2. Have symptoms of headaches pre-COVID and post-COVID changed?
As per neurologists, the symptoms have more or less remained the same. Headache, being a chronic disease is thought of as a red flag for COVID-19 only when there is other symptom accompanied with it like high fever. Headache is very rarely seen as a symptom of COVID. Its like, only 14% of times a COVID patient may end up suffering from a headache. If the headache pattern has remained the same as it was previously, then there is no need to chop and pick a new treatment for the same.
Q3. How do doctors differentiate between the kinds of Headache? Why and when should someone consider a treatment for a migraine?
Research suggests that about 75% of patients who visit a doctor because of headaches will have migraines, as it is the most common under-diagnosed form of a headache.
Even neurologists believe that headaches do get unnoticed and under-diagnosed at times as normal headaches. But many of such patients actually end up suffering from migraine. Migraine has got a typical feature, which can vary from duration of 24 hours to 3 days, and one may experience throbbing pain on one side of the head. However, the side may shift from one side of the head to the other. Also, it has been observed that people with migraine are averse to bright light, loud sounds and sometimes, they are even osmophobic – they don’t like strong pungent smells or sweet smells or perfume odors. Sometimes, these patients may feel light flashing in front of their eyes and then the headache starts. These all are the tell tale signs of having a migraine that can be differentiated from normal headaches.
Other types of Headache that we see, like a tension headache, are transient, occur in office hours and are mostly holocranial i.e. occurring on both sides of the head. Also these are milder in intensity as compared to migraines. But sometimes, people who have tension headache also feel that they may have a migraine. The other type i.e. a cluster type headache is rarest of all headaches and also the most devastating one. They are short lasting for 2 hours to 6 hours but they cause intense morbidity and patients feel intense pain in bouts. A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head.
Q4. Practical tips for managing migraines or chronic headaches?
Sustainability and consistency are the key points for managing any kind of headache! Following a typical dietary schedule – in which you eat at the same time everyday whether day or night. Even while sleeping, patients should try and wind down at the same time everyday. It sets their circadian rhythm in motion and the body works like a well-oiled machine. Next comes drinking about 2.5 litres of water daily to avoid headaches due to dehydration. Apart from this, as a practise people who are averse to sunlight should carry goggles, whenever they are out. There are more tips but half the battle is won when these are followed regularly!
Q6. What could be a silver lining to migraine as per neurologists?
Many doctors have observed that, people are often fascinated with the labelling of a particular diagnosis. So, sometimes people are happy if they have been diagnosed with migraine, because they now know that they are suffering from some condition that is in the books. This may be ironic but at times labelling relevant headaches as migraines may end up giving a certain amount of satisfaction to patients as it fuels their belief that there is something that needs attention!
However, one should understand that migraine is not a life threatening condition – it is not something that will cause immediate danger to their life, but yes, it does increases morbidity. People tend to have decreased work efficiency and they tend to have repeated attacks of migraine that could be difficult to manage in uncontrolled environments. They may sometimes have depression and may even end up with suicidal tendencies. But one has to remember that with a strict or proper schedule and the correct prophylactic drugs, prescribed by neurologists, overcoming the label of migraine can be done well.
It is important to know that not all headaches are migraine. Special attention should be paid to the correct diagnosis and treatment of any headache. Acute and preventive medication should be chosen carefully. With about 25% of India’s population battling with migraines, we feel that knowing more about the condition can help people combat this condition with ease.