Reduced Frequency of Migraine Attacks Following COVID-19

Abstract and Introduction

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 is a virus affecting different organs and causing a wide variety and severity of symptoms. Headache as well as loss of smell and taste are the most frequently reported neurological manifestations of coronavirus disease 2019 induced by severe acute respiratory syndrome coronavirus 2. Here we report on a patient with chronic migraine and medication overuse headache, who experienced remarkable mitigation of migraine following coronavirus disease 2019.

Case Presentation: For many years prior to the severe acute respiratory syndrome coronavirus 2 infection, a 57-year-old Caucasian male suffered from very frequent migraine attacks and for control of headaches he had been taking triptans almost daily. In the 16-month period before the outbreak of coronavirus disease 2019, triptan was taken 98% of the days with only a 21-day prednisolone-supported triptan holiday, which, however, had no longer-lasting consequences on migraine frequency. Upon severe acute respiratory syndrome coronavirus 2 infection, the patient developed only mild symptoms including fever, fatigue, and headache. Directly following recovery from coronavirus disease 2019, the patient surprisingly experienced a period with largely reduced frequency and severity of migraine attacks. Indeed, during 80 days following coronavirus disease 2019, migraine as well as triptan usage were restricted to only 25% of the days, no longer fulfilling criteria of a chronic migraine and medication overuse headache.

Conclusion: Severe acute respiratory syndrome coronavirus 2 infection might be capable of triggering mitigation of migraine.

Introduction

Migraine is a disabling and highly prevalent primary headache affecting more than one billion people worldwide.^[1] Genetics, as well as environmental factors, are known to contribute to this neurological disease.^[2] Migraine headache is frequently described as severe, throbbing pain on one side of the head, often accompanied by further symptoms such as nausea, vomiting, and sensitivity to light and sound.^[3]

Coronavirus disease 2019 (COVID-19) is a life-threatening condition caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and affected patients present with a wide variety of symptoms.^[4] In this respect, a multitude of neurological manifestations of COVID-19, including headache, have also been reported.^[5–7] In particular, headache with migraine characteristic features have been observed in patients with COVID-19 in both the acute and healing phases.^[8] While COVID-19 disease was generally described to be associated with either de novo headache, or worsening of migraine symptoms, the COVID-19 lockdown has been reported to be associated with both deterioration and also improvement of migraine symptoms.^[9,10] Here we report on a patient with migraine who experienced a 3-month-lasting prominent mitigation of migraine, directly following SARS-CoV-2 infection.