Migraine Symptoms Improvement During the COVID-19 Lockdown in a Cohort of Children and Adolescents

Abstract

Background: Pediatric migraine is among the most common primary or comorbid neurologic disorders in children. Psychological stressors are widely acknowledged as potential triggers involved in recurring episodes of pediatric migraine. As the COVID-19 emergency may have affected the levels of stress perceived by children and adolescents with migraine, the present study was aimed to understand the effect of COVID-19 emergency on symptoms intensity and frequency in pediatric patients. Methods: A cohort of 142 child and adolescent patients with a diagnosis of migraine was enrolled at the Child Neurology and Psychiatry Unit of the IRCCS Mondino Foundation in Pavia (Italy). Socio-demographic and clinical characteristics were obtained from medical records. An on-line survey was used to collect information on COVID-19 exposure, stress response to the lockdown period, anxious symptoms during COVID-19 emergency, as well as migraine symptoms intensity and frequency before and during the lockdown. Results: The great majority were outpatients ( n = 125, 88.0%), 52 (36.6%) had migraine with aura, whereas, 90 (63.4%) had migraine without aura. All the patients reporting worsening symptoms progression before COVID-19, had reduced intensity during the lockdown (χ 2 = 31.05, p < 0.0001). Symptoms frequency reduction was observed in 50% of patients presenting worsening symptoms before the lockdown, 45% of those who were stable, and 12% of those who were already improving. All patients who had resolved symptoms before COVID-19 were stable during the lockdown (χ 2 = 38.66, p < 0.0001). Anxious symptomatology was significantly associated with greater migraine symptoms frequency (χ 2 = 19.69, p < 0.001). Repeating the analysis separately for individuals with and without aura did not affect the findings and significant associations were confirmed for both the patients' subgroups. Discussion: A significant reduction of migraine symptoms intensity and frequency was observed in pediatric patients during the COVID-19 lockdown phase in northern Italy. The improvement in both intensity and frequency of the migraine symptoms was especially significant in patients who were stable or worsening before the lockdown. The reduction of symptoms severity during a period of reduced environmental challenges and pressures further highlights the need of providing effective training in stress regulation and coping for these patients.

Major Stress-Related Symptoms During the Lockdown: A Study by the Italian Society of Psychophysiology and Cognitive Neuroscience

“…Another open question concerns the need to find strategies for managing patients. For example, there are studies on the effects of lockdown in neurological patients, in neurodegenerative disorders ( 59 ), in Alzheimer's disease ( 60 ), in migraine and headache ( 61 ). These studies show us how the symptoms vary according to this new clinical/social situation and how remodeling is necessary to address the request for therapy and the therapeutic offer in a new way.…”

The impact of Coronavirus disease 2019 (COVID‐19) pandemic on migraine disorder

“…Parodi et al [ 10 ] compared the first 2 months of quarantine with the 2 months prior to the lockdown in Italy and showed that migraine patients had less migraine attacks and less severe headaches during the quarantine. Similarly, another study in Italy by Dallavalle et al [ 11 ] on children and adolescents in Northern Italy showed a decrease in the frequency and intensity of migraine, with and without aura, following the lockdown. Papetti et al [ 12 ] showed the same results and suggested that the decrease in school effort and anxiety were associated with a reduction in the frequency and intensity of headaches.…”

“…There were no published papers looking at migraine triggers in the time of the pandemic. However, anxiety, mood changes and increase in psychological distress associated with higher frequency of attacks and attention paid to media about COVID-19 has been reported as comorbidities in patients with migraine [ 7 , 11 , 14 ].…”

Migraine during COVID-19: Data from Second Wave Pandemic in an Italian Cohort

“…It was generally well accepted by the Italian population, in view of a rapid resolution of the pandemic. In that scenario, resilience could have increased the threshold for medical support and reduced the severity of migraine [ 2 , 3 , 4 , 5 ]. We cannot establish whether the perpetuation of the pandemic emergency contributed to the increase in migraine severity, or whether this was due to the natural evolution of migraine.…”

“…Recent studies on the effects of contagion diffusion and restrictive measures during the first wave of COVID-19 [ 1 ] have shown a mild improvement of migraine features in Italian cohorts of adults and children, probably due to a reduction in stressors and resilient behavior [ 2 , 3 , 4 , 5 ]. In a previous evaluation conducted by our group [ 2 ], we demonstrated that the longer the time of complete lockdown, the better the outcome of migraine in terms of days with headache, intensity, and symptomatic drug intake.…”