Paradigm shift in migraine management impacted by COVID-19 pandemic and the role of confounding factors inflicting the change

Objectives: To assess the impact of the COVID-19 pandemic on migraineur’s quality of life and confounding factors. Methods: This is an observational cohort study conducted in Rashid hospital, Dubai Health Authority, UAE. Study was plotted to assess migraine indices in pre-COVID period, pre-pandemic and pandemic periods and to evaluate the pandemic induced paradigm shift in migraine management. Results: Out of 840 migraineurs 201 patients were selected, with an obvious female predominance (78%). Migraine without Aura was found in 70% and Migraine with Aura in 29.9%. Mean MIDAS score during period I, II and II was 22.78, 18.58 and 17.92 respectively indicating certain degree of improvement rather than deterioration during pandemic (p=0.001). Interestingly significant reduction in both migraine frequency and severity from pre-COVID to COVID period was noticed (p=0.01). Parameters like headache days/month, use of abortive therapy and Emergency visits also declined. Chronic migraine (CM) showed more improvement than episodic migraine (EM). Confounding factors like distance working and lack of social/professional stress mainly rendered this change. A modified strategy to handle headache during any pandemic/crisis can ensure quality management of migraine. Conclusion: Migraine patients had a resilient behavior during the COVID pandemic and showed significant improvement of all indices. Confounding factors like distance working played the most favorable role.