Examining the Effects of Social Distancing on Migraine

An observational study reveals COVID-19 social distancing measures affected migraineurs' sleep, physical activity.

Social distancing practices adopted during the COVID-19 pandemic affected both physical activity (PA) levels and sleep quality among migraineurs, according to findings of a multicenter observational study published in Nutrients.

Changes in nutrition, sleeping habits and psychological distress resulting from the COVID-19 pandemic have been hypothesized to negatively impact individuals’ health and well-being. However, for migraineurs, both well-established genetic factors and external factors have had a known impact on migraine susceptibility.

“Indoor and outdoor environmental factors, including barometric pressure changes, bright sunlight, flickering lights, air quality, and odors, are usually reported as migraine triggers,” researchers wrote. “Additionally, conditions such as shift working, with a consequent disruption of the sleep–wake cycle and increased levels of stress, can contribute to an aggravation of migraine episodes.”

To better understand the impact of social distancing on migraine frequency and severity, and to explore the impact of lockdowns on PA, eating habits and sleep quality on migraineurs, investigators conducted an observational survey consisting of single detailed interviews with patients.

All participants were diagnosed with migraine with or without aura based on the International Classification of Headache Disorders, 3rd Edition, by neurologists, and were aged 18 or older. Data were collected from 261 patients who presented to Italian study centers between May 1, 2020 and July 1, 2020. The social distancing period was considered from March 9, 2020 to May 3, 2020 based on actions by the Italian government.

Patients completed a 4-part questionnaire on migraine characteristics, PA, eating habits and sleep. Migraine patients were classified as "worsened" if their monthly headache frequency increased during social distancing compared with before quarantine. In the opposite case, patients were considered "improved," authors wrote. If frequency of migraine attacks did not change between before and during social distancing, participants were defined as stable.

The majority of study participants (n = 186) had chronic migraine; 87% were female. Mean (SD) patient age was 44.5 (12.3) years. Analyses revealed:

  • During social distancing, 72 patients (28%) reported a headache worsening, 86 (33%) an improvement, and 103 (39%) a stable headache frequency
  • A significant decrease of PA levels during quarantine was observed in the whole study sample (median total metabolic equivalent task [METs] decreased from 1170 to 510; P < .001)
  • A significant difference was reported on median Insomnia Survey index (ISI) scores (from 7 to 8; P < .001), which were increased in patients who presented a stable or worsening headache
  • The reduction of PA levels was associated with worsening sleep

In addition, migraineurs’ dietary habits were less healthy during lockdown regardless of whether headache worsened, improved, or remained stable. “However, a positive correlation between an increased consumption of healthy foods and walking METs was described in patients who reported a stable headache frequency,” authors wrote. “These results might suggest that healthier dietary and lifestyle habits may have contributed to avoiding migraine worsening during the social distancing.”

Patients’ occupational status was not associated with course of migraine throughout social distancing.

Future studies monitoring PA levels, nutrition and sleep for several months after lockdown in this population could offer new information on the effects of social distancing on migraine.

Reference:

Di Stefano V, Ornello R, Gagliardo A, et al. Social distancing in chronic migraine during the COVID-19 outbreak: results from a multicenter observational study. Nutrients. Published online April 19, 2021. doi:10.3390/nu13041361