Migraine & COVID-19: Headache Triggers, Treatment, & More

Is migraine a COVID-19 symptom? Do headaches mean I am immunocompromised? These and other FAQs answered here by a top headache expert.

Stephen Silberstein, MD, former president of the American Headache Society and current director of the Jefferson Headache Center at Jefferson University Hospital in Philadelphia answers your top 10 headache and COVID-19 related questions, below:


#1. Is migraine a COVID-19 symptom? Does suffering from migraine mean that I am immunocompromised and at higher risk for COVID-19?


Migraine attacks are not a COVID-19 symptom. Migraine patients are not immunocompromised and there is no evidence that migraine affects the immune system.

That said, we are all under more stress during the pandemic. Beyond the difficult news that we are inundated with, we are also spending more time isolated in our homes. As stress is a common migraine trigger, it makes sense that people would get more migraines during the pandemic.

Before you think about treatment, think about ways that you can reduce stress and prevent the migraine from occurring. Try to get outside (following local corona guidelines of course) when you can.

Exercise and meditation are also great ways to reduce stress along with deep breathing exercises that can be done even while you are working. In addition, make sure to not drink excessive amounts of coffee and avoid caffeine withdrawal.


#2. Since the start of the pandemic I've been waking up every morning with migraine headaches. Can you explain why this is happening?

Getting a good night’s sleep is an important part of staying healthy in general and can also prevent migraine attacks. If you are waking up with a migraine headache, it could be that you are struggling to get quality sleep due to stress caused by the pandemic.

Beyond the stress-reduction techniques mentioned above, try to use your bed only for sleep. Avoid reading the news before bedtime if that is causing you stress. If you do watch television before going to sleep, make sure that it is a program you find relaxing. This is probably not the time to check out that scary, new crime story.

couple on the street wearing face masksWearing face masks in public helps slow the spread of the coronavirus but some find masks uncomfortable and worry they are causing migraine headaches.

#3. Wearing a mask triggers migraine for me. What can I do?

The CDC encourages all people over the age of 2 to wear face masks. Face masks are one of  best ways to curtail the spread of COVID-19. They prevent the spread of airborne droplets to others and may also keep you safe by preventing inhalation of larger droplets.

But many of my migraine patients say they find face masks irritating and tell me that face masks make them feel overheated. Migraine patients do tend to be hypersensitive and unfortunately those feelings can trigger migraine headaches for some people.  

It's important that the mask cover your face and nose completely but it does't have to fit tightly on the face. Be sure to wear a comfortable mask -- there are many options on the market. Look for masks with elastic loops that fit comfortable around your ears. Masks that tie behind the head instead may be a more comfortable option. If possible avoid wearing your mask for long periods and take frequent breaks.  

Avoid masks with holes cut into them that can't be closed for straws. Masks with a closable straw hole are safer.

#4. I normally go to the ER for my migraines when my at-home drugs aren’t working but am trying not to due to the pandemic. What should I do instead?

No one should ever go to the ER for migraines unless an associated symptom, such as vomiting, is becoming life-threatening. Talk to your physician about taking home some “rescue medicines.”

If you were given Prochlorperazine (brand name, Compazine) suppositories at the emergency room,  you can take these home with you. The ER is loud and bright and one of the worst places you can be with a migraine headache.

If your drugs at home are becoming less effective it could be because you are taking them too often. You can try using some of the FDA-authorized prescribed wearable devices to treat your migraines as well.


#5. There is a lot of noise about new, non-invasive treatments. How do I know which treatments are for me?

There are several treatments that both help prevent migraine or help treat attacks. I would split the various treatments into three categories:

  • Prescribed Wearable Devices. Several devices have come out in recent years that use different methods of treatment. They are worn on the arm, neck, and head and use different methods to treat migraine attacks. They tend to be just as effective as drugs.
  • Drugs. There are both over the counter and prescribed options. The prescribed options range from triptans, to newer (and more expensive) CGRPs. Botox is also used.
  • Non-Drug Preventative Options. As I outlined above, in the first question, stress reduction techniques such as meditation and exercise can help reduce migraine incidence.

It is important to talk to your physician about your migraines so that they can help you find what works for you. Each type of treatment will work differently for each individual. Effectiveness depends on many factors including your age and health history. Some devices are easier to use than others and the cost of each one can vary widely.

Keep in mind that you can try treatments in two or three of these categories at the same time since they do not interact with one another. 


#6. How do the devices work?

It depends on the type of device you choose. Each one on the market today works a bit differently. For instance, Nerivio, which is worn on the arm and used by many of my patients, uses remote electrical neuromodulation to signal the brain to turn pain off.

Another device that sits on the head makes use of transcutaneous magnetic stimulation to stimulate the surface of the brain. The idea here is that electrical current turns the migraine off.

There's also a pain-relieving device that can be affixed to the back of the neck that stimulates the vagus nerve — the peaceful and quiet nerve is activated during deep breathing.

Some migraine sufferers find pain relief placing a TENS unit on their forehead. TENS machines use weak electrical impulses to produce endorphins and localize pain relief.

Again, speak with your doctor about which treatments are right for you.


#7. My seasonal allergies seem to be a trigger for my migraine, is that possible? How do triggers work?

It would be unusual for allergies to cause migraine headaches. What's more likely is that you are being impacted by seasonal changes in the weather, allergens, and other factors. Gradual increases in daylight during the springtime can trigger migraines in some people.

In general with triggers, think about the surrounding factors that accompany a trigger.Certain things that are considered triggers are actually warnings of an oncoming migraine. For instance, one much-discussed idea right now is that chocolate is not a trigger for migraines, but the desire to eat chocolate is a warning sign of an oncoming attack.

Keep a daily diary to help you understand your triggers and their surrounding circumstances.


#8. Does migraine trigger anxiety/depression or vice-versa?

Migraine and depression are co-morbid. This means that while one does not cause the other, they are often associated. Someone who suffers from depression is more likely to also suffer from migraines later in life and vice-versa.


#9. What are the best places to live when you have a migraine?

Non-extreme climates with low levels of air pollution are great for migraine patients. High altitudes aren't recomended and states with extreme temperatures (such as the very hot climate in ArizonaIare not ideal. Always try out an area first  before moving there permanently. Short-term rental arrangements are an option in many places across the country.

Having family and friends, or a social network, nearby is also very important -- social isolation isn't healthy for anyone. Living in a low-stress environment and one that's conducive to preventative measures that don't involve using medication such as exercise and meditation are other helpful ways to reduce migraine.

#10. Will research ever discover why migraine headaches happen? Is there any hope for a cure in the near future?

Migraine is fundamentally a disorder of a hyperactive brain. People wonder, why does migraine persist through the generations? When we were cavemen and we were being attacked by an animal, it helped to have hypersensitive senses as an early warning system.

Migraine headaches are associated with that system, which helps to explain the increased sensitivity to certain sensory inputs such as light.

We are increasing our knowledge regarding the genetic aspects of migraine and we even know why some rare types of migraine occur. I do believe that as research advances, we will eventually reach the point where we can cure the condition.

*StephenSilberstein, MD, is the former president of the American Headache Society and a member of Theranica’s Medical Advisory Board.

Updated on: 09/17/20
Continue Reading:
The Empowered Patient's Guide to Migraine and Headache