The familiar, all-consuming pain hit Kate Sosin in early May: a migraine.
As a chronic migraine sufferer who typically experienced full-blown attacks a couple of times a month, Sosin simply thought: “Here we go again.”
But the intense migraine attacks started coming more frequently, and are “eating me alive,” said Sosin, a 35-year-old reporter for the 19th, an online news organization. The Los Angeles resident, who uses they/them pronouns, now has three to four bad days a week – despite an increase in medication and regular treatment through a headache clinic.
“Since May, I’ve gotten a few small breaks, but I haven’t been able to get it under control,” they said.
Sosin isn’t alone. Headache specialists say many of their patients have reported new or worsening symptoms this year – an increase that is believed to be largely triggered by the coronavirus pandemic and its impact on stress, daily routines and access to care. Headaches are also the most common neurological symptom of covid-19, the disease caused by the coronavirus.
“If you think of a pressure cooker, it’s adding more steam to the pot,” said Akhil Chhatre, an assistant professor of physical medicine, rehabilitation and neurosurgery at the Johns Hopkins University School of Medicine. Chhatre added that he has seen a “dramatic uptick” in both new patients and people with a history of headache disorders who say they are suffering more.
At the Mayo Clinic in Scottsdale, Ariz., Amaal Starling, a headache specialist, said she has had to adjust treatment regimens for at least 50% of her patients who have had “significant worsening” of their symptoms. (Some people, Starling noted, have said they are doing better given the flexibility of working or learning from home. “But that’s probably a minority of patients,” she said.)
Although there hasn’t been sufficient research into how people with headache and migraine conditions are faring during the pandemic, “it seems like the anecdotal data is telling us a story that certainly some people are suffering more,” said Linda Porter, director of the Office of Pain Policy and Planning at the National Institute of Neurological Disorders and Stroke.
This year has been the worst year for Sosin since they began receiving treatment at a headache clinic in 2013. “Before the pandemic started, I had really hit a point where I was doing pretty well,” Sosin said. Now, though, “I’m just really, really sick all of the time.” Sosin added that their partner also has started having migraines.
“Stress levels are through the roof, and people are struggling to cope and find ways to recalibrate to the new way of life that’s here for the foreseeable future,” Chhatre said. The ergonomics of sitting in front of computers for much of the day, combined with difficulty in maintaining good exercise habits, may be leading to some weakening of the muscles that surround the neck and head, he said.
Increased screen time also may be exacerbating people’s headaches or migraines, Porter said. “Lots of television, lots of Zoom meetings, lots of computer time,” she said. “That kind of lighting can be triggers for people.”
Sosin, who used to walk between 40 minutes and an hour a day, said being at home so much has left their body feeling cramped. “I just feel like we’re just crumpled up pieces of paper,” they said.
Wanda Ritter, 51, who has had migraines most of her life, said she relied heavily on regular exercise to help with her symptoms and went to the gym often. Now, Ritter said, her daily exercise has included performing yoga stretches, walking circles around her cul-de-sac with her dog and going up and down the stairs inside her house.
“I have had pain every day now,” said Ritter, a resident of Mauldin, S.C., who also hasn’t had access to her usual migraine treatment.
Even before the pandemic, people with headache disorders struggled to receive treatment, research has shown. A 2016 study found that less than 5 percent of people with chronic migraines obtained a consultation, diagnosis and treatment.
“There’s about 700 board-certified headache specialists in the nation, and there’s 40-plus million people with migraine,” Starling said. “So, there’s this huge disparity and need for headache specialists, and the other issue has always been that headache clinics are primarily in big cities.”
Many headache specialists have started seeing patients virtually, which reduced some barriers, Starling said. But patients with chronic migraines often depend on routine in-person visits with their health-care providers to receive treatments such as Botox injections, she added.
“If patients do not get this medication every 12 weeks as they should, it can definitely spiral things into a negative direction,” Starling said. The Scottsdale Mayo Clinic where she works, for instance, had to stop procedures at one point, because it lacked enough personal protective equipment.
Ritter, who usually receives Botox injections four times a year, said she has only seen her neurologist twice during the pandemic, in March and December. “I am two full treatments behind on the Botox, which means that the last three months have been hell, migraine-wise,” she said.
The pandemic also has deterred people who might otherwise go to an emergency room or urgent-care clinic during particularly bad attacks, Starling said. Both Ritter and Sosin said they have avoided those places, citing concerns about the coronavirus.
“In the back of my mind, it’s like, ‘I can’t go to the hospital,’ ” Sosin said. “I think I would have been able to break this a lot earlier, but I know that the ER is not an option.”
Sosin said they are in contact with their neurologist through virtual and in-person appointments, and they have also started to experiment with various at-home strategies to manage symptoms. They have found some success with stretching and Benadryl, and recently shared a thread of “tiny comforts” on Twitter.
Experts emphasized that people who are struggling with headaches or migraines should get in touch with a health-care professional. Many primary-care providers are “well-versed in addressing migraine diseases,” Starling said.
If you can’t get to a doctor, experts said there are various accessible strategies that could help make you less vulnerable to a migraine attack.
Starling recommended trying to maintain consistent sleep, exercise and eating habits. Aim for at least seven hours of sleep a night; going to bed and getting up around the same time; and 20 to 30 minutes of exercise, two or three times a week, she said, adding that a brisk walk can be sufficient. To prevent fluctuations in blood sugar, Starling encouraged eating six small meals throughout the day. You should also stay hydrated and keep a log of your headaches and migraines.
It is equally important to incorporate stress-management techniques into your daily routine, she said. A randomized clinical trial published this month in JAMA Internal Medicine suggested that mindfulness-based stress reduction, such as yoga, can improve the negative effects of migraine disease on quality of life, levels of depression and disability, among others.
“Everyone has stress, and we can’t always just reduce it,” Starling said, “but what we can do is we can learn to manage our stress in a more healthy way.”
Ritter, who does yoga stretches every morning and before she goes to sleep, said focusing on the present also helps. “We can’t think about the last nine months. We can’t think about the coming nine months,” she said. “If you just deal with the right now, you can get through anything.”