“Every one of us knows someone with severe migraines, which no one wants to talk about.”
It’s a normal response to have a painful headache. But when you are asked by friends and co-workers to describe it, and you do it only rarely, they may be wondering if something is wrong.
Covid-19, an autoimmune condition, is a type of migraine brought on by stress, trauma, other pain or joint injury. It often leads to longer, intense headaches, vomiting, breathing difficulties and fatigue that may last for weeks or months at a time.
The diagnosis is determined through a series of physical exams that involve a thorough examination of all the affected parts of the body. The tests look for inflammation of the nerve cells that control vision, in particular the retina, the back of the eye. They also look for inflammation of the nerve cells that control blood pressure, and some look for increased production of blood-pressure hormones in the spinal fluid.
Dr. Arielle Horowitz, assistant clinical professor of neurology at the University of Pennsylvania, and the lead author of a review on migraines published last month in the Canadian Medical Association Journal, said that in patients with various forms of migraine, there is sometimes an overlap in their symptoms, and the overlap depends on the triggers that make it worse.
Dr. Evan Miller, a neurologist at New York-Presbyterian/Weill Cornell Medical Center, said many of his patients with the condition come to see their doctors with headaches after very stressful situations that lead to sleep deprivation. “The person can go to bed at 10 p.m. and in the middle of the night he or she feels a headache start.” He tries to find out what other resources people can try in that situation.
In some cases, though, the headaches don’t go away after the relief of stress wears off. If that happens, Dr. Miller said, “It usually takes a second headache that is much more severe.”
The neurological tests are performed by a neurologist at the first and last session of the three- or four-hour test. Dr. Miller said they are very straightforward and easy to follow. If anything looks abnormal, it is usually treated by monitoring the patient.
“The patient really trusts the neurologist’s diagnosis of migraines, and that is one of the reasons they go back and forth to see us,” Dr. Miller said.
Some patients report that some of the effects of the condition are helped by a particular preventive medicine, such as ibuprofen. But Dr. Horowitz said it would be unwise to use ibuprofen as a prophylactic against a serious neurological condition such as the one her patients suffer from. “After Ibuprofen treatment for headache, there is an abnormal change in the disease process that makes people vulnerable to secondary acute attacks,” she said. “It is a matter of individual and irrational risk-benefit balance.”
The patients with depression, anxiety and sadness that are part of the syndrome get a more receptive response from their doctors. In fact, Dr. Horowitz said, some medication and psychotherapy that might help keep those symptoms under control can be helpful.
The symptoms of Covid-19 do not mean that migraines are impossible, Dr. Miller said. “Because the body is doing such a great job of managing the headache, that doesn’t mean there isn’t a way to prevent and treat this as an episodic headache and not as something that a lifelong migraine sufferer is getting,” he said.