Abstract
To the Editor:
Due to the recent coronavirus disease 2019 (COVID-19) pandemic infection, on 10 March 2020 Italy entered the lockdown and non-essential adult elective medical and surgical procedures were stopped.
According to these restrictions, clinical activities at our tertiary headache center in Rome were stopped until 4 May. Starting from June, the outpatient clinic reopened for urgent visits, and our local Health Authority rescheduled the visits cancelled during the lockdown. They settled priority criteria based on the risk attributed to each pathology, ranging from high to minimal risk. On the basis of this six-point scale of risk attribution, headache appears to be at “minimal risk” and therefore visits are rescheduled to a much later date, practically months after what was previously planned (1).
In order to investigate the impact of COVID-19 and lockdown on chronic migraine patients (2), we developed a 36-item self-report questionnaire divided into five domains. Each item was scored on a Likert scale ranging from 0–4: Never, 0; rarely, 1; sometimes, 2; often, 3; almost always, 4. In the first domain, we evaluated any concerns about migraine and drug therapy in relation to COVID-19 pandemia (score 0–28); in the second, about family and personal caregiving (score 0–16); in the third, about working activity (score 0–16); in the fourth, both general (4 G; score 0–32) and disease-related (4 DR; score 0–32) emotions during the lockdown; in the fifth, future expectations concerning health status, social life and working activity (score 0–20). We evaluated both a total score (0–144) and the impact on patients of each domain (none, mild and high impact), using cut-off values (see Table 1).
neuroCOVID-19 test.
A hundred questionnaires were emailed to the most recent consecutive chronic migraine patients visited at our headache center. Sixty-five patients replied (48 F, age 46.1 ± 12.8 years, education 14 ± 4 years) from 15 March to 4 May. Among them, 33 were married and lived with an average of two people per family. All patients were taking prophylactic therapy.
The figure shows the frequency of response and the degree of impact for each domain. The highest scores were detected in domains 4 and 5, investigating respectively general and disease-related emotions and future expectations. Therefore, the pandemic seems to have affected mostly the emotional sphere of our patients and their perspectives (see Figure 1).
Frequency of response and the degree of impact for each area. Domain 1: Concerns about migraine and drug therapy; Domain 2: Concerns about family and personal caregiving; Domain 3: Concerns about working activity; Domain 4 G and DR: Both general and disease-related emotions during the lockdown; Domain 5: Future expectations concerning health status, social life and working activity.
In our opinion, these issues are far from marginal and it is surprising that patients with chronic headache are considered less urgent than other chronic neurological patients.
The Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide; migraine alone is third among people aged 15–49 years (3). However, when it comes to reprogramming priorities, headache goes down to the last places, making any medical intervention difficult to implement promptly.
Even if migraine is a non-life-threating disease, the high disability experienced by patients with chronic migraine deserves the same attention as other chronic neurologic diseases in health policy and resource allocation.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
