Double vision. Partial blindness. Throbbing headache. Nausea. Sensitivity to light. There are myriad symptoms that migraine sufferers can experience, but for those prone to the condition, each and every one is a debilitating side effect that can last between several hours and a number of days. Contrary to popular belief, a migraine is not simply a headache. The neurological condition, which can appear in either childhood or adulthood, is frequently characterised by intense, pulsating, splitting pain, often localised in one part of the head. They can be a very individualised experiences, with some sufferers also experiencing vomiting, a tingling or numb sensation in the hands or feet, and sensitivity to sound. Those who suffer from what are known as migraines with aura, can also encounter symptoms such as trouble speaking or recalling words, and seeing flashing lights or temporarily losing vision. Whichever symptoms you suffer from, chances are that your migraines completely disrupt your day, rendering you unable to work. The frequency of attacks can vary wildly person to person but, according to whispers on social media and anecdotal accounts, many people are finding they are experiencing more migraines since the Covid-19 pandemic began. This writer is one of them. Typically experiencing a migraine every five to six months, I had an attack three weeks into social distancing measures, about three months since my last one. But could simply being home more really account for an increase in attacks? “Right now, in the world, everyone’s under collective anxiety and grief with what’s going on, and everyone’s dealing with it differently,” says Dr Sana Kausar, a family medicine consultant at King’s College Hospital Dubai. “I’m not surprised there is more of a trigger without it being one specific thing you would be aware of. Collectively, we’re all absorbing what’s going on – the world has changed a bit, we don’t know how long it will be changed for, there’s a lot of uncertainty.” Migraines can be triggered by any number of things depending on the sufferer. Some are susceptible to caffeine, others find attacks are brought on by a lack of sleep, some find fluorescent light aggravates the condition, others can be affected by something as seemingly innocuous as the weather or eating cheese. Triggers can, more crucially, also be psychological. “Some people get worse migraines when they’re stressed, angry, anxious or when they’re dealing with grief,” says Dr Kausar. “Currently, there’s a lot of uncertainty, where you’re missing your family, you don’t know how they’re getting on, you can’t get out to see them, so that’s not going to help with psychological triggers, which, to be honest, I think most people have.” Such worry, combined with news headlines dominated by the global crisis, could negatively impact the regularity of a sufferer’s migraines, agrees Dr Vivek Karan. “In a chronic migraine patient who is already in a fragile state of mind, this stressful external stimulus can lead to imbalance and cause a migraine attack,” says the stroke and interventional neurologist at RAK Hospital. “Even though people are safe in their homes during isolation, they do get information from newspapers, WhatsApp, Facebook, Twitter and other social media sites. This information is stressful, and people are uncertain of how the pandemic might pan out and this is affecting the allostatic balance, the amount of brain activity required to appropriately manage the level of emotional or physiological stress at any given point of time.” For new sufferers, to determine your trigger, Dr Kausar recommends keeping a diary of attacks, detailing what you ate that day, how you slept, how you were feeling and anything else going on in your life. For people experiencing attacks while staying home, she also recommends a number of preventative measures to incorporate into your daily life. “One of the things that can help pretty much everyone across the board is to take time out on a regular basis. So schedule time off – five minutes every hour or two – and take that time to close your eyes, breathe and meditate,” she says. "You can use apps and you don’t need to look at them, you can place your phone under the sofa.” A good, healthy diet, monitoring your caffeine intake and regular exercise, even just a few simple workouts with a mat and exercise ball in your apartment, are also lifestyle choices to adopt on a daily basis. And ensure you get at least six to eight hours of sleep a night and stay adequately hydrated, adds Dr Anandi Damodaran, a specialist neurologist at Medcare Hospital Sharjah. “Have a fixed time to go to bed and get up,” she recommends. “Getting fresh air and natural lighting may be beneficial. Some studies show that supplementation with low-dose vitamin D may help to reduce the number of migraine attacks. Take supplements after getting advice from your doctor.” Dr Karan also advises sufferers should not skip meals, drink about six to eight glasses of water per day, avoid perfumes, and limit their intake of tea, coffee, lemon, spices and foods rich in the compound tyramine, such as strong or aged cheeses and cured or smoked meats. “Manage your stress by relaxation in the form of meditation or exercise,” he says. “Establish realistic expectations about the pandemic, and strengthen your ego by telling yourself that you, your family, your job and everything else will be fine.” “Once one comes on, people usually have a strategy to make it go away, which might be a dark room, lying down, sleeping it off, and also a lot of people will take over-the-counter medication like paracetamol or ibuprofen,” Dr Kausar says. Start with such medication first, she advises, before visiting your healthcare provider to discuss prescription drugs should migraines prove too severe to be dulled with Panadol. “There are a lot of teleconsultations you can do now,” she says. “Don’t suffer too much, but try the basic things first.” A cold shower or gentle head massage can also ease symptoms, says Dr Karan. “Finding the exact reason behind your migraines is important in managing your triggers, but generally speaking, people feel better with magnesium-rich, alkaline diets, with lots of dark-green veggies, wholegrains and nuts,” he says. Ice packs wrapped in a towel or a cool cloth applied to the forehead and neck can also provide some relief, says Dr Damodaran. For chronic sufferers, monthly injections have shown positive results. “In recent years, monoclonal antibodies which target CGRP – calcitonin gene related peptides – have been developed,” Dr Damodaran adds. “These are used for reducing the frequency of acute attacks.” The current situation is stressful enough without heaping unnecessary pressure on yourself, whether by feeling guilty for being unproductive or working longer hours due to your close proximity to the computer. “We’re living through difficult times, and we have to think about it in a positive way. We’ve still got access to healthcare, food, entertainment, and the freedom to go out for a walk. We need to refocus and look at the positive aspect of it, because that will also make a difference. It’s all about mental well-being,” Dr Kausar urges. “People want to be seen to be online all day, they want to be seen to be working hard but actually, psychologically, they’re pushing themselves and you need those little breaks. “Enough is enough at some point. Have good boundaries between your work time and your home time – put yourself first.”
