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Suffers from migraines are experiencing more frequent and severe migraines since the start of the coronavirus pandemic. That's according to a new survey from the Migraine Association of Ireland. But how do we account for this increase and what can be done to help those with the affliction? We're joined by Dr. Martin Rutledge, consultant neurologist at Beaumont Hospital and Hermitage Medical Clinic, and Jane Wheelan, who suffers from migraines. Good morning to you both. Now, Dr. Martin Rutledge, first of all, how significant a spike is it in the recurrence of migraines?

Good morning, Pat, and thanks for having us on the show. And I think at the moment, you know, we've been going on with this pandemic for six months and there has been a spike in terms of patients struggling more and patients being more anxious and more migraine be more frequent. But I think things are starting to normalize because we have clinics back up and running. We have much more support than we had in the first couple of months of the pandemic.

So part of the reason why people might have suffered more frequently is, I presume, a reluctance to be in touch with their GP.

Well, I think everybody was cut off at the beginning, like we were even in Beaumont Hospital in March. We were we were afraid. We were we were panicking a little bit. But once we got moving again and realigned ourselves, then it was within a few weeks we were able to get back in contact with patients, start virtual clinics, and then we started to face to face. And so obviously there was that there was a sort of a startle moment where where everybody even in the hospital, we were we were quite frightened that we were going to be overwhelmed and everybody was redeployed.

So we had a we had a period of time where we were a little bit and in chaos, but pretty quickly reorganized ourselves and and I think then got back to supporting the patients.

Now different people will report different triggers for their migraines. Is there anything about a pandemic, about the stress of isolation or lockdown that might make such attacks more frequent?

Well, it's not only the lockdown, it's it's your behavior. Every day you go to the shops, you're worried. People are anxious, even interacting in the slightest of ways. So especially at the beginning, I think as the months gone on have gone on, as I said this, that things have lessened somewhat. But certainly the stress worrying about going to the shops, a lot of my grinners would be would be very worried about getting covid on top of their migraine and then having a double whammy, especially the more chronic migraine patients who have symptoms, you know, more often than not.

So anxiety is a trigger. Yeah, there are many. You know, if you ask a couple of thousand people what are most common triggers are stress is one of the top five. So hormonal stress not eating regularly. Stormy weather and sleep disruption are the top five triggers or exacerbations of migraine. And especially if you have a lot of patients and probably up to 100000 patients in Ireland who've got chronic migraine. So in other words, 15 days a month or more, they have headache or migraine symptoms and they're are often much more anxious than the general population.

And obviously, covid just made things worse. Hmm.

I can imagine, too, that it's a feedback loop, that if you have a migraine and then you're worried about its recurrence, you actually encourage its recurrence.

Well, it's funny that you talk about others. If you look at migraine patients who to migraine attacks for five days each per month, and they're they're meant to be back to normal in between, there's a heightened anxiety even between the migraines because they're afraid of the next one coming. So then you add another layer of anxiety and stress on top of that, which is covid and and interacting with other human beings. And you get a you get a little ticking time bomb for some of the patients.

How many people in Ireland do we know what you know, how many and a thousand would suffer from migraine?

We think up to 20 percent of the population. So if you think we've got nearly five million people in Ireland, we think 800000, 900000 snowboarder's exact because migraine comes in all different shapes and sizes. You can have the chronic ones that I just talked about, which is perhaps 100000, but then you have people who might have three migraines a year. So it really is quite variable in terms of severity and disability. What is some more chronic patients who struggle the most?

Yeah, and the kind of symptoms that people get. I mean, headache is obviously, you know, crippling headache is the one that we'd all kind of associate with migraine. But I mean, are things like photophobia, nausea, those associated funny.

Jane and I were just sitting out of the reception area. Newstalk and the TV screens were annoying, Jane. They weren't annoying me. And even putting on the headphones, she said, can I turn down the volume to your producer? So Jane's in a migraine phase at the moment. A normal stuff like brake lights and noise is amplified. So your brain is amplifying those inputs and that's why she doesn't like it. She she wanted the sound turned down and she turned away from the TV.

So we better talk to Jane then. Jane, how long have you been suffering from migraines?

I passed over 30 years, probably since my early teens. I don't quite remember when, but I've had them over 30 years. It's been a long, long time of trial and error, trying to figure out what it's all about and how to help myself. So.

So. So how often would you have episodes and how do they manifest themselves?

Well, I would have started as a teenager just having them now and again. And then in my 20s, I began to get them more regularly and ended up by my late 20s being in that chronic phase that Martin talked about.

I'm back more in an episodic stage now, but I can quite easily slip back into a chronic stage if I if I'm not careful.

So kind of self-management and being aware of my triggers, doing the things like Martin was saying there about regulating sleep, all those things are so important for me that I've got to maintain those to keep my brain happy.

And then how it manifests is really this has changed over the years as well. So like everyone thinks of somebody lying in a dark room, but what they don't see is all the other little things that happen, like the nausea, vomiting. That would been a huge thing when I was younger. I have that pretty much under control now, but it's the photophobia. I'm very sensitive to movement.

So even though I'm not moving, something around me is moving like the TV and that was mentioned there or smells really aggravate things. And also my allergies over the years has gotten worse as well.

So that's a kind of an oversensitivity to maybe I'll feel the clothing on my skin or even if I have my hair tied up or I'm wearing a bracelet or a watch that I feel quite painful and which obviously for anyone else, it would feel completely normal.

There'd be nothing, nothing at all wrong.

Not everyone would love a magic pill for migraine. So what sort of medications are available and what ones are effective? So I think for the first time in three decades, we have a magic pill for some patients and we have new treatments which are specifically designed for migraine. These are called monoclonal antibodies. Now, they're not a pill. They're an injection, which you do once a month. But there are four of these new monoclonal antibodies. And the last 30 years and in the last 18 months, we've started to use them.

So for about two thirds of patients, they work really well. For about one third of patients, they don't work at all. But for the more chronic patients that we talked about earlier, the monoclonal antibodies seem to be doing the trick, which is great.

I didn't ask the basic question, I suppose, which I should have done. What causes migraine?

Oh, it's it's a brain problem, as we've talked about. So you have a scenario where your brain goes into a mode where it's sensitive to lights and smells and you get headaches and nausea and feeling unsteady and facial pain and sinus congestion. So you've got a condition whereby your brain becomes hypersensitive and then you've got a situation where your brain go back, goes back to normal, hopefully, and most patients. So it's a neurological disorder which doesn't have any significant long term sequelae in terms of, you know, morbidity and mortality, in terms of you're not going to die younger if you have chronic migraine.

But it can be very disabling for for many, many years. So it's more the disability rather than it being sinister. And finally, I should ask you, Jane, have you found the pandemic and all associated with it has been exacerbating your migraines?

Yeah, that's a really interesting question. I think for me, the summertime is actually usually quite a good phase. So when we when we started off in March, obviously the whole kind of overnight working from home, everything changed. All the anxiety, the fear, not knowing what was going on, I was really worried. Is this going to aggravate things? Am I going to move back into a chronic phase? So I really took a lot of, I suppose, action to to mind myself and do what I could.

And the Migraine Association were really helpful as well of issuing updates and help to people. There aren't a lot of online events and workshops and seminars to try and reach out and help people. That was very helpful. I did a lot of things myself, working from home. I work from home. In the past, I knew what I needed to do to set my workstation up in a way that wouldn't I wouldn't get my next train, that would aggravate things.

I took regular breaks. I found obviously working from home. You're looking at your screen for a lot longer than if you're in an office where you're moving around.

Maybe so I had to just take those breaks, get outside at lunchtime, go for a walk. And, you know, things like the gym was closed. So even though I'm not a big exercise person, I do try to do a little bit of moderate exercise to help manage my migraine. So with the gym closed, I had to look at what else can I do?

So it was a very yeah, quite a challenging time.

I I'm lucky I've had a lot of help over the years and I have a lot of support from family, friends, everyone around me. And so for me the pandemic was OK, obviously the isolation and those, as Martin said, even being afraid to go to the shops, you know, so everyone was very isolated. I we all can connect. That resonates with everybody. But with migraine, there is quite a lot of isolation anyway.

And so that was a big factor, I suppose, of just trying to find ways of keeping in touch with people and that side of us.

But thankfully, yeah, over the summer I was OK. I'm now going back September. October is always a bad time of year for me. I'm entering back into a bad phase that has nothing to do with the pandemic. It's probably more the changeable weather. And I don't know if it's the change in daylight hours or what, but this is always a bad time of year for me.

So, um, well, I hope it eases and I hope the flashing TV screen and just hope that things much damage today.

Jane, thank you very much for joining us. That's Jane Wieland who suffers from migraines, and Dr. Martin Rutledge, consultant neurologist at Beaumont Hospital and Hermitage Medical Clinic. Thank you both very much.

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