It has been shown that everyday habits, lifestyle and stress can have a substantial influence on migraine frequency.1,2 The COVID-19 pandemic significantly disrupted the everyday life of people around the world, examples of this including the emergency lockdown in Italy in March of this year.2 Therefore, Claudia Altamura (Department of Neurology, Campus Bio‑Medico University Hospital, Italy) and her co-authors hypothesised that the imposed lockdown and the accompanying sudden change in life routine might have influenced migraine frequency and disability in treated migraine patients. 2 In particular, the authors were interested in the effect of the lockdown on migraine patients taking calcitonin gene-related peptide (CGRP)-pathway inhibitors.
Patients from two clinical studies enrolled
To answer their research question, Dr Altamura and her team recruited 147 patients from two ongoing observational, longitudinal, multicentre studies.2 The two studies investigated erenumab and galcanezumab, both monoclonal antibodies inhibiting the CGRP pathway, in migraine patients within a real-life setting. On average, patients were at the sixth administration of the respective antibody therapy. The impact of the lockdown was determined by collecting data on monthly migraine days, monthly painkiller intake and monthly disability scale (Headache Impact Test [HIT]-6) in the month before and in the first month after lockdown imposition. In addition, the researchers collected data on working and household situations of enrolled patients.
Reduction of migraine days and disability scale during lockdown
Interestingly – and unexpectedly, as the authors state in their publication – it was found that patients experienced a reduction in monthly migraine days (P=0.024) and disability scores (P=0.009) when comparing pre- and post-lockdown data.2 However, the monthly painkiller days did not change significantly. None of the parameters were found to differ according to work settings, household, or COVID-19-related family loss. Notably, the authors found the strongest reduction of migraine days, disability scores and painkiller days in patients who had received less than three antibody doses.
Potential explanations for unexpected results
“Despite the dramatic storm hitting the everyday lives of Italian citizens, […] we observed, somehow unexpectedly, that the COVID-19 pandemic lockdown substantially spared its impact on a cohort of migraine patients receiving therapy with monoclonal antibodies inhibiting the CGRP pathway”, the authors concluded.2 The data, and especially the improvements seen in the first months of therapy, confirm that the investigated drugs are rapidly effective in migraine patients. Additionally, patients in later administration cycles were not significantly affected by the lockdown. The authors hypothesise that this could have either been due to an effect of CGRP pathway inhibition on stress induction, or that the lockdown situation-induced stress did not provoke migraine attacks due to the release of the protective corticotrophin‑releasing hormone. Unfortunately, due to the fast and sudden nature of the COVID-19 pandemic, the authors were unable to include a control group, leaving a few points open for speculation.