Migraine management during the pandemic

By: Dr Kay Kennis, GP with a special interest in headache

Dr Kay Kennis shares tips on managing migraine during this challenging time. The questions are divided into three sections: mental health, self-care and accessing medical support, and managing complex migraine.

  1. Mental Health

Stress and anxiety

We know that stress and anxiety can trigger migraine for some people, and finding ways to manage these can help to manage the impact of migraine.

Many people will have experienced some stress and anxiety over the last few months. It’s a normal reaction to the situation we all find ourselves in. However, for people with migraine the implication of this stress and anxiety may be an increase in attacks; or more anxiety and stress about the thought of the situation triggering an attack.

You may find the NHS Every Mind Matters resources a useful starting point. You might also find this blog providing tips to help people manage their migraine during coronavirus helpful. If you are finding things too much and are really struggling to manage your stress and anxiety you should speak to your GP.

Low mood

We know that many people with migraine experience low mood from time to time. The current coronavirus situation is likely to be making this more challenging, especially as appointments are cancelled and it’s not clear when things will return to normal.

If you are feeling low you may benefit from speaking to someone – you may want to talk to a friend or family member. If you don’t feel comfortable with this you can contact Samaritans (24/7) on 116 123. The NHS Every Mind Matters site has a range of resources you may find helpful as well.

If you are having thoughts about harming yourself you should contact your GP urgently (or 111 if out of hours). Most areas in the UK have a 24-hour support service for urgent psychological support you can be re-directed to.

For those with migraine, stress, anxiety and depression can act as a ‘double whammy’, as they usually make migraine worse or can trigger a migraine. They also make us less able to cope with the physical and emotional problems we have.

If you are feeling stressed, anxious or depressed it’s important to ask for help. You may feel that the situation isn’t serious enough, or that you don’t want to ‘bother’ your GP. However, it’s really important to seek help when you need it, and it’s important to persevere.

  1. Self-care and accessing medical support

Self-care

We know that many people successfully manage their migraine, and that good self-care can help with migraine management. It may seem more challenging at the moment because of the circumstances you find yourself in, but there are lots of things you can do to self-manage your migraine during Coronavirus (and beyond).

If you already have good self-care management in place, keep doing what you’re doing. Although be aware it may need a bit more effort at the moment.

There are some general things that may help:

  • Take care of your mental health (see above).
  • Try to keep to a regular routine (as much as you can) including getting up and going to bed at your normal times.
  • Try to exercise regularly, and get outside if you can. Going for a walk, gardening or following a daily exercise class such as Joe Wicks can help.
  • Try to stick to a healthy diet and make sure you’re eating regularly throughout the day (sticking to your normal routine as much as you can).
  • Drink at least two litres of fluid a day, and avoid too much caffeine and alcohol.
  • If you smoke, now might be a good time to try stopping.
  • Avoid taking too many painkillers, and don’t stop your usual medications unless advised to by your doctor.

GP consultations

Many people are unsure whether their GP is still providing consultations or how these are currently being managed.

At the moment GP’s are not allowed to see anyone face to face without talking to them first. This can be frustrating, but is keeping people safe by reducing the chance of spreading the virus.

How this works will be different in different surgeries. Some people have to fill in an online form, others will need to tell the receptionist a little about their problem before a GP rings them back.

The GP may need to look at you over a video call, but often this is not necessary.

Occasionally the GP may ask you to attend for a face to face consultation. If this happens there is usually a ‘safe site’, away from the area where coronavirus patients are assessed. Do be aware that the doctor seeing you will have to wear a mask, apron, eye protection and gloves. This can be disconcerting if you are not expecting it.

Certificate of fitness to work/ fit note

Some people with migraine will need to get a fit note from their GP for their employers if they are off work for more than five days. GPs can still provide these, although it is likely they will be provided electronically and you can email them to your employer.

If you’re off for less than five days you should self-certify.

Prescriptions

Many people with migraine rely on prescription medication to help them manage their attacks. It’s understandable to be worried about delays or shortages of medication.

If you are already on regular prescriptions you should not notice a change. It may take longer to go to the pharmacy though, due to the social distancing requirements.

Try to arrange to collect the medication yourself if you are not socially isolating, or via a friend or relative. If there is no one available to collect your prescription each local council has a service to help vulnerable people.

New medications are taking a little longer to process as the pharmacies have a large volume of work. Your GP will be able to send your prescription electronically straight to your chosen pharmacy. You should check how long it will be before you can collect the prescription when you speak to the GP.

Changes in migraine

We know that some people are finding their migraine have got worse or increased in frequency during the current crisis, and we also know many people don’t want to contact their GP unnecessarily.

If you experience an increase in the number of migraine you should try to self-manage at home (as much as you can) initially. If this doesn’t improve your migraine you should contact your GP for advice.

If you get new or different types of migraine, you should contact your GP straight away and ask for a review. At the moment to access the GP most people have to tell the receptionist about their problem, or fill in an online e-consult form. Make sure you tell them that this migraine is new or different to your usual ones so the doctor knows this needs urgent review.

Some headaches will need emergency assessment in hospital so don’t wait for your GP to open if you have a sudden onset severe headache, a headache associated with fever, or headache with part of the body not feeling or moving properly that has never happened before.

Going to A&E

Some people may experience pain and symptoms that are unbearable, and may not be sure whether they should go to A&E.

If you’re experiencing a new severe headache which started instantaneously, or have a headache associated with part of the body not working (which isn’t like your usual migraine symptoms) then call 999.

If you have a new headache with fever call 111 as the fever means you will need to be managed in a specific area of A&E.

It’s not a good idea to attend A&E with your usual migraine and this would put you and others at risk. Follow the advice above to help you manage your migraine.

  1. Managing complex migraine

Headache clinics

We know many people have had their appointments at the headache clinic postponed or cancelled. Headache services are doing all they can to provide patients with information and support to manage their migraines during the current crisis.

Some people may want to contact their GP to see if they can provide treatment or support as an interim measure. You should only contact your GP if you need support at this time. If your migraine is stable, or you are meant to be having a medication trial, it is best to await your review or contact your headache clinic for support. Your GP cannot provide injection therapies.

If you need help contact your GP. If your GP is uncertain about what to do then they can still access advice from the local neurology or headache service.

Outpatient treatments

We know that many people with migraine have had their outpatient treatment appointments, including Botox and Greater Occipital Nerve (GON) blocks, cancelled or postponed.

This is very difficult for a lot of people at the moment. When it comes to trying to manage the impact of this the main thing is to try not to go backwards. Do not take simple painkillers like paracetamol or ibuprofen on more than 15 days of the month. Don’t take triptans on more than 10 days / month. Avoid opiates like codeine.

Focus on all the ‘non-medical’ care that you know about already, such as taking care of your mental health (as above), keeping active, spending time outside when you can, eating healthily, drinking plenty of fluids but avoiding caffeine, trying to maintain a regular routine and sleep hygiene through the whole week. Avoid excess alcohol. Think about stopping smoking if you are a smoker. Use a preventer if there is one that you have found does help at all.

As soon as it is safe the outpatient services will be up and running again.