Migraine and stress in a post Covid-19 world

By: Dr Manuela Fontebasso, GP with a special interest in headache and author of ‘Migraine and other headaches’

There is no doubt we are living in unprecedented times and for those who experience migraine, as well as their friends, family and co-workers, migraine is always and will always be unpredictable. I am sure that you all have developed your own tried and tested coping strategies over the years and have your own support mechanisms in place. What happens if you don’t, or they stop making a difference.

Migraine episodes, your headache threshold and stress

Each person will be able to identify very specific ‘actions’ that will often lead to the development of a migraine. This can vary from day to day, week to week and month to month, making your life and chance of experiencing a migraine attack completely unpredictable. So why is it so unpredictable, why does it change so much?

What is your headache threshold and why does it matter?
The higher your headache threshold the less likely you will experience a migraine episode. The lower your headache threshold the more likely you are to experience a migraine episode

What has an effect on your headache threshold?
A migraine brain needs a stable environment so there are many things that could lead to instability and lower your headache threshold. Examples include erratic meal patterns, poor fluid intake, erratic sleep patterns, stress and anxiety, and the unpredictability of life and loss of routine.

Stress and Covid-19

Since Covid-19 hit the headlines in early 2020, and a country-wide lockdown changed our lives, we have had to adapt to a new way of living our lives. This has had direct and indirect consequences on each and every one of us, in ways we could never have anticipated.

What has been the hardest thing for you about lockdown?
Loss of freedom; loss of control; loss of routine; uncertainty over the future; working from home; home schooling your children; shopping (getting an online order slot, visiting the supermarket); concern for friends and family; missing your holiday.

This list will vary from person to person, as we each see, feel, experience and react to the journey of life differently. Each individual will respond to imposed changes, evolving rules and regulations in varied and unpredictable ways.

In my experience stress is often the most potent factor that will lower your headache threshold and lead to an increased frequency of your migraine episodes.

What will be the hardest thing about post lockdown rules and regulations?
Each and every one of you will have different ideas and experiences which will govern how you react and respond to the people around you. The news and social media all seek to inform but actually look to create ‘headlines’ and ‘sensation’. This makes it harder for each of us to be well informed and able to make evidence-based decisions for ourselves.

How do these resonate with you?
Uncertainty (impact on friends and family, impact on children’s education and long-term future, financial concerns); unpredictability (working from home or not, lockdown or not, to travel or not); inconsistency (different rules in different places, individual choices and behaviours).

Covid-19 and migraine

There is no doubt that as the days, weeks and months have passed headache experts around the world have:

  • Seen patients develop headache symptoms for the first time after becoming infected with Covid-19
  • Found that migraine sufferers have experienced an increasing number of migraine attacks whether they have been exposed to Covid-19 or not
  • Found treating post Covid-19 headache is challenging
  • Found that reducing managing migraine frequency in patients with an increased frequency is proving to be challenging
  • Found there are a variety of new and established treatment options that have been of benefit for some of the people some of the time
  • Know there is a lot more to learn about Covid-19 and how it affects those who are exposed to it

So, while we know some things, we (each and every one of us) are all learning at the same time. There are no right or wrong answers at the moment.

How can I help myself?

As individuals we can take personal responsibility for what we do and how we do it, but we also recognise that there are some things we have no control over. In order to help ourselves we have to work out what our worries and concerns are. We then can then break down each of these in order to consider what if any changes can be made.

There are times when making change has a positive impact, and times when that change may have unexpected and unwanted consequences. Any change that we make must be considered carefully to make sure it really is the right choice and will produce the positive outcome we are looking for.

Regular meals

  • Don’t go more than four hours in the daytime and 12 hours overnight without eating (or drinking)

Avoid instant sugars as that generates peaks and troughs in your blood and brain sugar levels (remember the migraine brain needs stability)

  • Instant sugars are cakes, sweets and biscuits, as an example
  • More complex sugars include basmati rice and other low GI (Glycaemic Index) foods
  • Low GI foods allow a slow steady release of sugars into the blood stream and offers that stability
  • Understanding about GI, and what the GI of your plate of food can also help you
  • Here is a useful article about the GI index
  • Your goal is foods with the smallest GI number
  • Diabetics find it useful to understand about GI and food types as it helps their diabetic control to have steady sugar levels
  • This link will offer more information

A good fluid intake, ideally as water

  • Be cautious about caffeine intake as too much caffeine will lead to the chance of a rebound headache if your caffeine levels fall below 200mg in your blood
  • Aim for good hydration, two litres of water a day
  • Avoid artificial sweeteners, if you can
  • Try and avoid skipping meals, go for healthy snacks
  • If travelling manage food and fluid intake

Regular sleep patterns will always help

  • Changing shift patterns often cause problems so regulate your food and fluid intake if they can’t be avoided

Good posture is always important

  • Think about your back and neck at all times
  • Avoid anything that puts your neck under strain
  • Local heat will often help
  • Gentle neck massage can help

Stress is always tricky

  • Control and actively manage the things you have some control over so those things you have no control over are less likely to affect you
  • Plenty of fresh air and exercise is always beneficial
  • Put yourself first at least once every day
  • Don’t forget the importance of ‘me’ time to get life in perspective

Ask for help

  • If you don’t ask for help family and friends won’t realise you need it
  • Don’t say “no” when help is offered
  • Seek help early so you don’t get overwhelmed
  • Seek professional advice (don’t be afraid to ask, ask for more information if you need it, ask for clarification if you don’t understand the advice offered)

There are no easy answers, and solutions don’t always present themselves at the first time of asking. Everyone may need to seek a different solution and that takes time, effort and persistence.

We are all stepping in to an uncertain future but we can help and support each other, that way we can find a way of moving forward in a positive way.