Stage 4 lockdown is in place, schools and most workplaces are still closed, going for a walk outdoors is only allowed between 6-9am, and a strict curfew is in place. Given the current landscape it’s not surprising you’ve had more patients complaining of headaches as stress increases the environment for headaches and migraines to occur.

More than just a headache, migraines are often accompanied by a deep throbbing sensation behind the eyes, temples, or the back of the head that can last hours—or as much as several days [Image: drobotdean/Freepik].

HEADACHE OR MIGRAINE?

“It’s important to distinguish between headaches and migraines, because it means you can give more effective treatment for faster relief,” said Dr Yaseen Yacoob, specialist neurologist at Mediclinic Pietermaritzburg. “In short, a headache is usually a dull pressure that occurs mostly around the forehead, but also around the temples or back of your neck, affecting both sides of the head. Migraines, on the other hand, are intense, throbbing pains usually on one side of the head, and come with other symptoms like nausea and dizziness.”

TENSION HEADACHES

Tension headaches are by far the most common type of headache. A tension headache is the dull, aching, pressure headache, which often develops after a stressful day or during times of emotional upheaval – particularly when overtired and anxious.

Unlike some migraine headaches, visual and nervous system symptoms (such as flashing lights, distorted vision, tingling or numbness in the face or hands) do not occur prior to the onset of tension headaches.

While they don’t cause nausea, vomiting, or sensitivity to light, tension headaches do cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day.

PREVENTION

The goal of treatment is to stop headaches from occurring. Good headache management depends on reducing stress and tension. John Hopkins University recommends:

  • Going to sleep and waking at the same time each day
  • Exercising each day for at least 30 minutes
  • Eating regular meals without skipping any, especially breakfast
  • Avoiding headache triggers, such as certain foods and lack of sleep
  • Resting in a quiet, dark environment as needed
  • Stress management (yoga, massage, or other relaxation exercises)

TREATMENT

“For most headaches, simple over-the-counter analgesics like paracetamol are usually the first line of treatment,” said Dr Yacoob. “If the headache is persistent and/or doesn’t settle with simple analgesics, you should advise patients to seek professional medical help.”

However, Dr Yacoob cautions to steer clear of non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen, as these may affect the gastric lining and kidney function, among other side effects, if taken over a long period of time.

MIGRAINES

As migraines can be triggered by stress, it is particularly key to manage stress during the pandemic.

According to Dr Sommer Ebdlahad, a Neurologist at the Virginia Spine Institute, “Your body reacts to stress so strongly that it’s the most common trigger for patients with migraines. Up to 70% of people with migraines see stress as a trigger,” says Ebdlahad.

More than just a headache, migraines are often accompanied by a deep throbbing sensation behind the eyes, temples, or the back of the head that can last hours—or as much as several days. Patients with migraines often display other neurological symptoms such as sensitivity to light and sound, nausea, vomiting, blurred vision, and difficulty concentrating.

“The intensity of a migraine is determined by a number of factors and can range from mild headaches to debilitating episodes,” explained Dr Peter Haug, a neurologist at Mediclinic Milnerton in Cape Town.

“There are two types, the common migraine and the classic migraine. Common and classic symptoms include one-sided, throbbing pain, accompanied by facial aching, nausea, and a sensitivity to light, smells, and sounds. Classic migraine sufferers experience an ‘aura’ that lasts a few seconds or minutes, which includes seeing zigzag, wavy, or coloured lines or shapes in one visual field,” said Dr Haug. “Less common symptoms include dizziness or one-sided weakness. Migraine headaches are often experienced with muscle tension headaches, which can take several days or weeks to improve.”

TREATMENT

“I like to recommend exercise because it metabolises stress hormones that our body produces in response to stress, and instead it produces the good endorphins to help get you feeling better and help your brain destroy that chemical imbalance,” said Dr Ebdlahad.

“Migraine headaches can potentially be stopped by the prompt intake of medication, and symptoms are frequently better after lying down and sleeping,” said Dr Haug. “Usually, migraines respond to anti-inflammatories, which should be taken as early as possible at the onset of pain. Anti-nausea medication can boost the effect of migraine medication. Most over-the-counter migraine kits can be effective concoctions but shouldn’t be taken in repeated doses or long term. Patients with frequent or debilitating migraines can benefit from the daily intake of a low-dose oral antidepressant at night, or a low-dose anti-epileptic that blocks certain ion channels and acts as a nerve stabiliser, also at night. The chronic daily intake of painkillers for muscle tension headaches following migraine attacks must be avoided.”

MANAGING STRESS DURING COVID-19 PANDEMIC

As both headaches and migraines can be triggered by stress, it is particularly key to manage stress during the pandemic.

Firstly, Professor of Neurology Dr Joseph Sirven recommends avoiding too much time on social media and news coverage of the pandemic. “You don’t have to watch second-to-second coverage of how the virus is impacting us,” he said. “Give yourself some breaks. Maybe check in once in the morning and then again in the evening so you know what the big headlines are and make sure you haven’t missed anything. But otherwise give yourself a break from the news of the day so it doesn’t just become an echo chamber which increases that sense of stress.

“Secondly, take care of yourself. Make sure to eat, stay hydrated, all those good things that help to prevent infections to begin with,” Dr Sirven said. “Exercise. Taking a walk outside in some sunshine can give you that sense of relief, which is a huge element of stress management. Then focus on the positive. Despite all the scary headlines, there are a lot of positives too. Lastly, take time to reflect. Whether that’s meditation, taking some deep breaths, or if you’re spiritual pray. Just feel that other connection that there are other powers at play if you will. And if that brings peace, so be it.”