If Pandemic Stress Has Made Your Migraines Worse, You're Not Alone

According to the results of a survey from the Headache and Migraine Policy Forum (HMPF), many people living with migraine disease have experienced more migraine episodes during the COVID-19 pandemic.

Many of the respondents also reported that they have been having a harder time managing their migraine symptoms and feel that their overall health and well-being have suffered.

Verywell spoke to several experts about the survey, as well as what people living with migraines can do to better manage their symptoms amid the added stress of the pandemic.

The Survey

The HMPF survey asked more than 1,000 people living with migraines in the United States how the pandemic has affected their health, including their ability to manage their symptoms and access care.

Nearly 70% of individuals living with migraine disease reported that they had experienced an increase in monthly migraine attacks since the start of the COVID-19 pandemic.

Of the respondents, 84% said that they felt more stress managing their disease, and 57% believed that their overall health had declined.

The people who responded to the survey identified several factors that led to the increase in their migraine episodes, including changes in their work environments, additional burdens related to working from home with children, and the reluctance of health insurance companies to adapt to new treatment options.

Pandemic Changes Challenge Migraine Management

“There’s been a whole host of new challenges for migraine patients,” Peter McAllister, MD, Medical Director and Chief Medical Officer of the New England Institute for Neurology & Headache, tells Verywell. “When things shut down, many healthcare providers closed their offices. Patients who were coming quarterly to get Botox injections could not get them. If they got a migraine as a result, they were not going to go to the ER because it was full of COVID patients.”

Adjusting to a work-from-home environment puts additional strain on people living with migraine disease, particularly those who have school-aged children.

“There are many potential triggers to a migraine attack, but the number one for most people is stress, and there’s nothing like a global pandemic to trigger stress,” McAllister says. “Many young women are trying to work remotely on Zoom, causing or worsening their migraines. If they had children, the schools shut down, which also increased stress at home.”

Changes At Work

According to the report, only one-third of people who experience migraine attacks are able to work full-time. Others who are able to work require modifications and accommodations.

“Those who live with migraine disease are typically in the prime of their working years,” Lindsay Videnieks, JD, Executive Director of the HMPF, tells Verywell. “Attacks can last a few hours or weeks, and there is an uncertainty of when you can get back to life. Anxieties over I might lose my job, I don’t know if my kids will be able to homeschool, or Can I even leave my house? are all triggers and have caused instability for persons living with migraine disease.”

Migraine triggers that are common in the workplace include perfumes, fluorescent lights, noise, flashing lights, and stress. In some cases, triggers might be able to be avoided—but only if employers are aware of the need and willing to make changes.

“There are accommodations that employers can make," Videnieks says. "But there is a gap in knowledge about their responsibilities."

Adapting Migraine Care During the Pandemic

Some insurance companies have made policy changes to migraine care during the pandemic, but survey respondents said that it has not been enough.

Less than 30% of respondents said that their insurance providers had made it easier for them to access their medications, such as by eliminating the need for prior authorization, waiving step therapy requirements before proceeding to other treatments, and allowing for more medication per refill.

“While one would expect that insurance companies would be more accommodating, that has not changed significantly,” Videnieks says. “Migraine patients are the fourth highest users of ER services. Why would you not provide more access to treatment options that would keep people out of the ER?”

The HMPF has been working with insurers to address coverage gaps in migraine care. “This has been our busiest year,” Videnieks says. “We’ve been trying to keep the community updated on those changes and work with like-minded groups to ensure any gains in access are preserved.”

Consistent care and preventive treatment are crucial to migraine disease management. “The keyword for migraine patients is stability," Videnieks says. "If an insurer decides to switch therapy, that brings instability to an already uncertain situation."

Instability also makes it more likely that people living with migraine disease will need to seek care. "We want to keep folks healthy and keep them from going to the ER because symptoms cascade if you are not effectively treated," Videnieks says. "We are trying to work with insurers to make sure that doesn’t happen.”

How Telehealth Changed Migraine Care

According to the HMPF survey, only 22% of respondents used telehealth before the COVID-19 pandemic. Now, 78% reported that they have had a virtual visit with their provider.

Of the people surveyed, 61% said that they were afraid to visit their physician’s office, and 74% did not want to seek emergency care because they were afraid of contracting COVID.

McAllister says that his practice chose to stay open with strict precautions in place that would allow patients to continue to receive the migraine treatments they need, but telehealth has also played a crucial part in care delivery during the pandemic.

“Telehealth fills in when the patient can’t come in, and I have some patients who just like the convenience of it,” McAllister says. “I’m able to listen to my patients, make decisions, and send prescriptions to their pharmacy.”

Still, there are aspects of care that he cannot achieve during a virtual visit. “While telehealth was a good stop-gap measure, it doesn’t replace human interaction, eye contact, or physical examination," McAllister says. "And you can’t administer medications that involve giving injections,” which he adds are often more potent or faster-acting than oral medications.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.