MIGRAINE MONITORING IN THE TIME OF COVID-19: TRIGGERS AND PROTECTORS DURING A PANDEMIC

Scoping Review: The Effects of Interrupted Onabotulinumtoxin A Treatment for Chronic Migraine Prevention During the COVID-19 Pandemic

Objective

To systematically examine the literature on the clinical consequences of inadvertent delays in scheduled onabotulinumtoxin A (OTA) therapy for chronic migraine during the COVID-19 pandemic and assess recommendations when access to OTA is limited.

Background

The coronavirus (COVID-19) pandemic was unprecedented in its impact on the global medical community. Most healthcare institutions in the United States (US) and the world had begun significantly limiting elective procedures, undermining management of many debilitating chronic conditions. OTA injections, were similarly involuntarily postponed, leading to significant setbacks in symptom control.

Methods

A comprehensive literature search was conducted on databases of Medline and Embase with search timeframe defined as the point of database inception to March 1st, 2024, and the search was performed on March 2nd, 2024. The search strategy was independently formulated by two authors (QR and CR) and was reviewed and approved by all authors of the article after appropriate amendments.

Results

A total of nine articles met the defined inclusion criteria. They collectively demonstrated marked delays in OTA treatment with decline in migraine symptom control measured in the form of migraine intensity, frequency, as well as patient satisfaction in disease management. Quality of care in the form of follow-ups also appeared compromised. Alternative strategies of telemedicine and the administration of calcitonin gene-related peptide monoclonal antibodies (CGRP mAb) were adopted in place of conventional treatment.

Conclusion

The COVID-19 pandemic had caused marked clinical deterioration in the migraine patient populations across US, Europe, and the Middle East. Strategies employed to circumvent this limitation included the adoption of remote consultation via telemedicine as well as the use of pharmacological agents such as CGRP antagonists. In the event of a reoccurrence of a worldwide pandemic, strategies should be implemented to prevent the cessation of needed treatment for those suffering from chronic migraine.

Determinants of the mental health status of university students in Japan: comparison between pandemic and recession periods during the 7th wave of COVID-19

Introduction

Although the number of identified coronavirus disease 2019 (COVID-19) cases and deaths has decreased, the repetitive crest-trough pattern of the spread of COVID-19 has yet to cease. The current situation may affect the mental health status of university students who are distracted in their academic and daily lives by the pandemic. This cross-sectional study aimed to identify the determinant factors of the mental health status of Japanese university students before and in the middle of the 7th wave of the pandemic, one of the largest waves to be experienced in Japan.

Method

A survey was administered to two groups of students during the recession period between the 6th and 7th waves (n = 156) and during the 7th wave of the pandemic (n = 97).

Results

T-tests showed no statistically significant differences between the two groups in Perceived Stress Scale (PSS) scores, while the COVID-19 anxiety scores (p < 0.001) and General Health Questionnaire (GHQ) scores were significantly higher in the Pandemic period group (p = 0.011). The multiple regression model indicated that PSS scores were the only determinant of GHQ scores in the Pandemic period group.

Discussion

The results indicate that stressful life events, such as the COVID-19 pandemic and daily hassles, which are measured by the PSS, affect students' mental health differently. Therefore, the author submits that school counselors should provide counseling to students to reduce anxiety caused by daily hassles, during recession and pandemic periods. Students also require assistance with the reduction of stress and anxiety caused by daily hassles, regardless of the pandemic situation.

Migraine, associated factors, and functional disability in medical students at a peruvian university during the COVID-19 pandemic: An analytical cross-sectional study

Background

It is unknown whether the confinement caused by the coronavirus disease 2019 (COVID-19) pandemic may influence migraine triggers. This study aimed to determine the frequency of migraine and their associated factors in medical students at a Peruvian university. The characteristics of migraine episodes and degree of functional disability caused by migraine were also evaluated.

Methods

An analytical cross-sectional study was conducted on medical students of a Peruvian university. The suspected migraine was determined with the Migraine Screen Questionnaire. Sociodemographic, confounding, and COVID-19 pandemic-related variables were included as possible associated factors. Poisson regression models were used, and crude and adjusted prevalence ratios with 95% confidence intervals were estimated.

Results

The participants comprised 327 students, and 30.3% (n = 99) had suspected migraine. Sex, clustered semesters, having family members with migraine and COVID-19 risk factors, and hours in front of the computer were associated with a higher probability of migraine. However, having more hours of sleep per day was associated with a lower probability. Moreover, most students with migraine had a severe functional disability (41.4%).

Conclusions

The high frequency of migraine in medical students could be due to COVID-19-related quarantine. Certain pandemic-related factors increase the probability of having migraine. A high level of disability should promote timely diagnosis and follow-up in affected students.

The Pathophysiological Relationship Between Migraine and SARS-CoV-2 Infection: A Comprehensive Literature Review

People with migraine, and individuals with other neurological conditions, have suffered in multiple aspects during the COVID-19 pandemic. This paper will discuss the factors that impacted the neurology department. The emergence of severe acute respiratory syndrome coronavirus 2 in late 2019 has generated new challenges in healthcare systems across the globe. Similar to the fields of pulmonology and cardiology that saw an increase in research, the neurology department was in search of possible relationships between COVID-19 and other medical conditions. Research on the possible common pathophysiological mechanism between COVID-19 and migraine is currently being studied. The most recent hypothesis suggests the following: migraine is caused by an increased release of calcitonin gene-related peptide from the trigeminal ganglion, which will cause an increase in nitric oxide and IL-1β, resulting in vasodilation and inducing hyperalgesia. COVID-19 causes an increase in nod-like receptor protein 3, which causes the production of IL-1β and again induces an inflammatory response. This review article looks at the mechanisms of migraine and COVID-19, and tries to link a common pathophysiological pathway between the two. This report also serves as a gateway for further research regarding possible management that could potentially target both of these mechanisms.

Associação entre comportamento alimentar e hábitos de vida e aumento de crises de migrânea em universitários na pandemia da COVID-19

Introdução: A pandemia da COVID-19 provocou alterações nos hábitos de vida e padrão alimentar da população, importantes gatilhos para as crises migranosas. Objetivo: Avaliar a associação entre comportamento alimentar e hábitos de vida e aumento das crises de migrânea em universitários na pandemia da COVID-19. Material e Métodos: Estudo descritivo, de corte transversal, retrospectivo, realizado com acadêmicos de universidade de Salvador, Bahia, entre dezembro/2020 a junho/2021. Os universitários foram convocados pelo Whatsapp® e pelo e-mail institucional e direcionados ao termo de consentimento livre e esclarecido e questionário, preenchidos via aplicativo de gerenciamento de pesquisa. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, sob parecer 4.351.573. Dados analisados por meio de estatística descritiva. Resultados: Amostra de 83 indivíduos, 89,2% mulheres, 45,8% sedentários, 51,8% ganharam peso recentemente, 73,4% apresenta baixa ingestão hídrica, 59% têm dificuldade para conciliar e 50,6% têm dificuldade de manutenção do sono. Antes da pandemia, 7,3% relataram 7-14 dias de enxaqueca por mês e, após, aumento para 24,1%. 36,1% dos acadêmicos associaram alimentos às crises de enxaqueca, sendo os principais gatilhos: café (20,5%), chocolate (14,5%), embutidos (12%), álcool (9,6%) e açúcar (6%). O aumento dos dias com enxaqueca associou-se à dificuldade de manutenção do sono (p < 0,002). Conclusão: Apesar do resultado estatisticamente significante apenas entre a dificuldade em conciliar o sono e maior frequência de enxaqueca, as mudanças no estilo de vida e comportamento alimentar ocasionadas pela pandemia da COVID-19 também parecem implicar no aumento de dias com enxaqueca em universitários.

The impacts of masks and disinfectants on migraine patients in the COVID-19 pandemic

Since the onset of the COVID-19 pandemic, the use of personal protective equipment (PPE) and disinfectants has become necessary to prevent transmission of the virus. However, the effects of such pandemic obligations on chronic diseases such as migraine have not been fully elucidated. We aimed to investigate the effects of the COVID-19 pandemic, as well as the use of masks and disinfectants, on migraine patients. A total of 310 migraine patients were included. Demographic data, migraine characteristics, and mask and disinfectant use were obtained through a face-to-face survey. Patients were grouped as worsening, stable, or improving according to pre-pandemic and pandemic migraine characteristics. Migraine worsening was found in 177 (57.1%) patients, stable course in 96 (31%) patients, and improvement in 37 (11.9%) patients. The use of scalp contact masks and double masks and daily mask duration were higher in the worsening group (p:0.005, p:0.005 and p:0.001). In addition, the frequency of personal disinfectant use was higher in this group (p:0.011). In regression analysis, mask type, daily mask duration, presence of allodynia, being a health worker, depression score, and odor were determined as independent risk factors for migraine worsening. We found a worsening of migraines in more than half of patients during the COVID-19 pandemic. We also demonstrated a relationship between migraine worsening and mask type, number of masks, and intensive disinfectant use. Migraine patients should be advised of optimal prevention methods based on individual social and working conditions rather than exaggerated preventative measures.

Non-invasive vagus nerve stimulation for prevention of migraine: The multicenter, randomized, double-blind, sham-controlled PREMIUM II trial

AIM

Evaluate the efficacy and safety of non-invasive vagus nerve stimulation for migraine prevention.

METHODS

After completing a 4-week diary run-in period, adults who had migraine with or without aura were randomly assigned to receive active non-invasive vagus nerve stimulation or sham therapy during a 12-week double-blind period.

RESULTS

Of 336 enrolled participants, 113 (active, n = 56; sham, n = 57) completed ≥70 days of the double-blind period and were ≥66% adherent with treatment, comprising the prespecified modified intention-to-treat population. The COVID-19 pandemic led to early trial termination, and the population was ∼60% smaller than the statistical target for full power. Mean reduction in monthly migraine days (primary endpoint) was 3.12 for the active group and 2.29 days for the sham group (difference, -0.83; p = 0.2329). Responder rate (i.e. the percentage of participants with a ≥50% reduction in migraine days) was greater in the active group (44.87%) than the sham group (26.81%; p = 0.0481). Prespecified subgroup analysis suggested that participants with aura responded preferentially. No serious device-related adverse events were reported.

CONCLUSIONS

These results suggest clinical utility of non-invasive vagus nerve stimulation for migraine prevention, particularly for patients who have migraine with aura, and reinforce the well-established safety and tolerability profile of this therapy.Trial Registration: ClinicalTrials.gov (NCT03716505).