From wading through the complexity of treatment options, to accessing specialist support virtually, Una Farrell, The Migraine Trust, homes in on how migraines can be managed during the pandemic.
From early on in the COVID-19 crisis, we were hearing from people seeking our help that the pandemic was seriously impacting the management of their migraine.
We ran a survey of over 2,000 people with migraine to understand what was happening and what could be done to help. The results were worrying.
It found that a large number (58 per cent) of people’s migraines has worsened since the beginning of March. It also found that 17 per cent can’t access the treatment / medication that they had been receiving for their migraine; 17 per cent of people had appointments with specialists postponed or cancelled; and eight per cent were unable to get an appointment.
It was clear that more needed to be done to help people with migraine. Many people’s condition was worsening at a time when access to care and treatment is restricted.
Wherever you are in a migraine patient’s journey, you can help by understanding the full range of healthcare that is available to them during the pandemic, and explaining their options to them.
The New Migraine Healthcare Landscape
While migraine care has been greatly impacted by the COVID-19 pandemic, healthcare professionals are working hard to continue to provide care to people with migraine. Many are adapting their practices and finding new ways to offer support. Here is an overview of the different ways in which they are providing help with migraine during the pandemic.
For many people their GP is their main healthcare provider for help with their migraine. They may be able to diagnose migraine, provide information, and prescribe acute and preventive treatments to help manage them. Some GPs specialise in headache and they are often known as a ‘GP with a special interest in headache’.
However, sometimes people need more support than their GP can provide. For example, if they are not responding well to treatment, there is doubt over their diagnosis, or their symptoms are becoming more debilitating. In these cases their GP should refer them to a specialist, such as a headache clinic.
How are GPs Supporting People During COVID-19?
Many GPs have had to adapt how they work to support people during COVID-19. This includes offering more telephone and virtual consultations when there isn’t a need to physically assess someone. For more details on how their GP is operating they can visit their website or give them a call.
Pharmacies can provide a range of services for people with migraine, including fulfilling prescriptions and consultations about their symptoms so that they can recommend appropriate treatments.
They can recommend painkillers, such as paracetamol, NSAIDs (aspirin, ibuprofen and diclofenac) and combined analgesics containing paracetamol that can be used as first-line treatment to relieve pain from all headaches. There are also treatments that can be combined with paracetamol, such as buclizine and prochlorperazine to treat the nausea.
Sumatriptan can also be provided ‘over-the-counter’ to people with a migraine diagnosis. The pharmacist will ask about any cardiac risk or contraindications to taking sumatriptan before providing it.
How are Pharmacies Supporting People During COVID-19?
As with many other healthcare providers, pharmacies have had to adapt how they are working. How they have been affected will vary from pharmacy-to-pharmacy, but may include only one person at the counter at a time and reduced opening hours.
Some pharmacies may not be providing consultations for the time being.
Many people with migraine need to be seen by a specialist to access specialist support and different treatment options. This is usually for people who have a complicated migraine presentation, unusual features, have not responded to preventive treatment offered by a GP, or where a diagnosis is unclear. Who someone sees will depend on their local area; if possible it’s advisable to be seen by a headache specialist but people may also be seen in a general neurology department or a pain clinic.
A headache or migraine clinic specialises in the diagnosis and treatment of migraine and head pain. The clinics are often linked to a neurology department in a hospital and are directed by a consultant neurologist or doctor with a particular interest and expertise in migraine.
Each NHS migraine clinic will have its own referral criteria and people will need to be referred by a medical practitioner. This is most likely to be their GP, but could be a hospital doctor or other healthcare professional within the NHS.
Headache clinics have access to a wider range of treatments and have more expertise in managing migraine, and other headache conditions. Many will also have a nurse specialist to provide support, information and treatments to people with migraine.
How are Specialists Supporting People During COVID-19?
Unfortunately, many specialist appointments and treatments (such as Botox) have had to be cancelled due to COVID-19. This is to ensure the safety of staff and patients; and also (in some areas) due to staff being redeployed into other areas of the NHS.
Where they can, specialists are continuing to provide information, support and treatment via telephone and virtual consultations; and are working hard to ensure that treatments can restart as soon as possible, although there may be a delay in access for some people when clinics resume.
If they have had an appointment or treatment cancelled, or have an upcoming treatment, they should contact their clinic to find out what options are available to them until their appointment or treatment resumes.
To keep up-to-date on all things migraine-related, individuals can sign-up to The Migraine Trust e-bulletin at
www.migrainetrust.org, and by following us on Twitter – @MigraineTrust, and Facebook – themigrainetrust.