- COVID-19 pandemic causes change in daily routine, increases anxiety and brings other stressors that could trigger or worsen headaches.
- Headache has been described as an early symptom of COVID-19. Clinicians should review other symptoms and exposure risk for patients with new onset of severe headache or a worsening one.
- Minimize visits and procedural treatments. Telemedicine should be use when possible.
- Acute treatments should include NSAIDs, triptans and anti-emetics as first line medications.
- NSAIDs, triptans and neuroleptics can be used as combination therapy if needed.
- Bridge approaches include NSAIDs, neuroleptics, long-acting triptans, anti-epileptics and corticosteroids (which, in patients with SARS-CoV2, could extend duration of viral replication and should be considered only for patients without exposure and symptoms).
- Prevention with onabotulinumtoxinA injections are proscribed due to close contact between patient and provider. Instead, ACE inhibitors or ARBs , melatonin and zonisamide can be used.
These recommendations are based on the American Headache Society’s article on migraine care during COVID-19 pandemic. It is intended for clinicians caring for patients with migraine and for health insurance providers in order to withdraw barriers to quality care. The article reviews previous studies on telemedicine, medications for migraine and their potential effect in COVID-19.
Currently, no data associate NSAID, ACEI or ARBs with adverse income in COVID-19 patients.
Szperka C.L., Ailani J. and al. (March 30, 2020) Migraine Care in the Era of COVID-19: Clinical Pearls and Plea to Insurer. The Journal of Head and Face Pain. https://doi.org/10.1111/head.13810