Demographic data, working status, living conditions, and daily habits
A total of 433 migraine subjects agreed to be interviewed, while only 10 patients did not give their consent. The mean interval that elapsed from the beginning of the quarantine and the time of the interview was 31.9 ± 4.5 days (20–40 days), without significant differences across participating centers. Demographic characteristics of enrolled patients are presented in Table 1. Patients in northern Italy were older than in central and southern Italy; education level was higher in northern and southern Italy (Table 1). Days spent at home after start of quarantine were fewer in northern Italy as compared to the other two areas (Table 1). In northern Italy, less patients were unemployed, and more patients lived in urban areas, whereas in Central Italy fewer patients were able to telecommute (Table 1).
Table 1
Baseline characteristics of the included subjects
| All (n = 433) | North (n = 105) | Center (n = 101) | South (n = 227) | Statistic Comparison | P value |
Gender, n (%) | | | | | χ2 3.7 | NS |
Female | 333 (76.9) | 77 (73.3) | 73 (72.3) | 183 (80.6) | | |
Male | 100 (23.1) | 28 (26.7) | 28 (27.7) | 44 (19.4) | | |
Age (years), mean ± SE | 43.97 ± 0.63 | 47.24 ± 1.17 | 42.00 ± 1.51 | 43.36 ± 0.71 | F 4.9 | 0.008* |
BMI, mean ± SE | 24.1 ± 0.002 | 24 ± 0.004 | 24 ± 0.005 | 24 ± 0.003 | F 0.12 | 0.880 |
Education years, n (%) | | | | | | |
0–5 | 16 (3.7) | 2 (1.9) | 4 (4.0) | 10 (4.4) | | |
6–8 | 84 (19.4) | 29 (27.6) | 21 (20.8) | 34 (15.0) | | |
9–13 | 175 (40.4) | 33 (31.4) | 52 (51.5) | 90 (39.6) | | |
>13 | 158 (36.5) | 41 (39.0) | 24 (23.8) | 93 (41.0) | χ2 18.8 | 0.005 |
Days of staying at home for quarantine mean ± SE | 29.27 ± 0.58 | 24.6 ± 1.98 | 32.26 ± 2.00 | 31.56 ± 1.35 | F 4.9 | 0.008** |
Home place, n (%) | | | | | | |
Countryside | 76 (17.8) | 2 (1.9) | 40 (39.6) | 34 (15.0) | | |
City | 183 (42.3) | 58 (55.2) | 32 (31.7) | 93 (41.0) | | |
Small town | 174 (40.2) | 45 (42.9) | 29 (28.7) | 100 (44.1) | χ254.7 | < 0.0001 |
No. of cohabiting family members during social distancing, mean ± SE | 2.32 ± 0.13 | 2.34 ± 0.26 | 2.36 ± 0.2 | 2.26 ± 0.17 | F 0.49 | 0.95 |
Work, n (%) | | | | | | |
Unemployed | 208 (48.0) | 38 (36.2) | 58 (57.4) | 112 (49.3) | | |
Employed | 225 (52.0) | 67 (63.8) | 43 (42.6) | 115 (50.7) | χ29.6 | 0.008 |
Employment, n (%) | | | | | | |
Telecommuting | 89 (20.6) | 26 (24.8) | 12 (11.9) | 51 (22.5) | | |
Regular working | 48 (11.1) | 25 (23.8) | 19 (18.8) | 44 (19.4) | | |
Lost job | 88 (20.3) | 16 (15.2) | 12 (11.9) | 20 (8.8) | χ216.5 | 0.036 |
BMI indicates body mass index; NS, not significant; SE, standard error |
F: One-way ANOVA test |
χ2 : Chi square |
*P < 0.01 (North vs Center) post hoc Bonferroni test |
**P < 0.05 (North vs Center vs South) post hoc Bonferroni test |
Table 1.
Quarantine was not associated with changes in food intake, sleep, and alcohol assumption (Table 2).
Table 2
Reported change in daily habits during social distancing in the included patients according to geographic areas
| All (n = 433) | North (n = 105) | Center (n = 101) | South (n = 227) | χ2 | P value |
Food intake, n (%) | | | | | 0.6 | 0.67 |
Increased | 67 (15.5) | 18 (17.1) | 14 (13.9) | 35 (15.4) | | |
Reduced | 153 (35.3) | 32 (30.5) | 32 (31.7) | 89 (39.2) | | |
Unchanged | 213 (49.2) | 55 (52.4) | 55 (54.5) | 103 (45.4) | | |
Alcohol consumption, n (%) | | | | | 0.89 | 0.89 |
Reduced | 85 (19.6) | 20 (19.0) | 25 (24.8) | 40 (17.6) | | |
Increased | 13 (3.0) | 5 (4.8) | 2 (2.0) | 6 (2.6) | | |
Unchanged | 344 (79.4) | 89 (84.8) | 74 (73.3) | 181 (79.7) | | |
Sleep quality, n (%) | | | | | 0.68 | 0.6 |
Improved | 157 (36.3) | 39 (37.1) | 37 (36.6) | 81 (35.7) | | |
Worsened | 45 (10.4) | 8 (7.6) | 11 (10.9) | 26 (11.5) | | |
Unchanged | 229 (52.9) | 58 (55.2) | 53 (52.5) | 118 (52.0) | | |
Table 2.
Effects of quarantine on migraine, emotions, and lifestyles
Migraine subjects living in southern Italy experienced more anger and reduced happiness, as compared to patients in northern Italy (Table 3). Patients living in central Italy reported more sadness compared to patients in northern Italy (Table 3).
Table 3
Reported intensity of emotions related to the COVID-19 emergency on a 0–10 scale according to geographic areas. Data are in mean ± standard error.
| North (n = 105) | Center (n = 101) | South (n = 227) | F | P value | P value (Bonferroni) |
Anger | 3.83 ± 0.27 | 4.15 ± 0.27 | 4.81 ± 0.18 | 5,2 | 0.01 | < 0.01 (South vs North) |
Disgust | 3.63 ± 0.26 | 3.39 ± 0.27 | 3.18 ± 0.18 | 0.3 | 0.70 | - |
Fear | 5.54 ± 0.27 | 5.71 ± 0.28 | 5.81 ± 0.19 | 0.3 | 0.71 | - |
Anxiety | 5.65 ± 0.28 | 5.97 ± 0.28 | 5.72 ± 0.19 | 0.4 | 0.68 | - |
Sadness | 4.70 ± 0.27 | 5.65 ± 0.28 | 5.40 ± 0.19 | 3.3 | 0.04 | < 0.01 (Center vs North) |
Happiness | 5.39 ± 0.23 | 4.67 ± 0.23 | 4.24 ± 0.16 | 8.7 | < 0.01 | < 0.001 (South vs North) |
Table 3.
During quarantine, 177 subjects (55.1%) reported worsening, 42 (13.1%) no change, and 102 (31,8%) improvement of mood. In northern Italy, mood was unchanged in 57% of subjects and worsened in 31%, while in southern and central Italy mood was unchanged in 42% of subjects and worsened in 43%.
Most patients subjectively reported that their migraines did not change since the start of quarantine (supplementary Table 1) and did not consider migraine as a facilitating factor for COVID-19 infection, although this opinion did prevail in southern Italy.
Headache frequency in pre-quarantine was similar among the three different geographic areas. Preventive treatments for migraine were used by 289 (66.74%) of the total number of patients. Headache frequency at baseline did not differ according to the use or not-use of preventive medications (Supplemental Table 2). A reduction in the number of days with headache, days with acute medication intake, and of migraine intensity, was observed during quarantine as compared to pre-quarantine (Fig. 1;Table 4).
Table 4
Comparison of headache features before and during lockdown period in the included patients. Result of repeated measures ANOVA are reported. Data are reported as mean ± standard errors.
| | All (n = 433) | | North (n = 105) | | Center (n = 101) | | South (n = 227) | | | | |
| Before | During | F (before vs during) | P value | | Before | During | | Before | During | | Before | During | F(geographic area) | | P value | P value (Bonferroni) |
Monthly headache days | 9.42 ± 0.43 | 8.28 ± 0.41 | 15.5 | < 0.001 | | 10.57 ± 0.81 | 11.03 ± 0.78 | | 8.19 ± 0.84 | 6.02 ± 0.80 | | 9.50 ± 0.56 | 7.78 ± 0.53 | 6 | | 0.003 | < 0.001 (South and Center vs North) |
Acute medication days | 8.32 ± 0.51 | 7.19 ± 0.54 | 7 | 0.008 | | 10.21 ± 0.96 | 10.79 ± 1.02 | | 7.29 ± 0.98 | 5.07 ± 1.04 | | 7.46 ± 0.65 | 5.70 ± 0.69 | 3.6 | | 0.027 | < 0.01 (South and Center vs North) |
Headache intensity | 6.93 ± 0.10 | 6.71 ± 0.11 | 6 | 0.014 | | 6.57 ± 0.19 | 6.59 ± 0.21 | | 7.25 ± 0.21 | 7.03 ± 0.22 | | 6.96 ± 0.21 | 6.50 ± 0.14 | 3 | | 0.05 | NS |
NS indicates not significant |
Figure 1
Table 4.
However, findings were unevenly distributed across the three areas. In fact, in northern Italy improvements were not observed. Moreover, discontinuation of preventive treatment for any reason, including adverse events or difficulties in dispensing drugs, prevailed in patients living in southern Italy (Supplementary Table 2). Changes in headache parameters were also similar among patients living in different urban areas and with different levels of education. Alcohol use, smoking, eating, and subjective perception of sleep quality did not affect headache frequency and intensity, use of symptomatic drugs, or working situation.
We found a correlation between reduction in headache frequency and increase in the number of days of quarantine (ANOVA with repeated measures with days of social distancing as covariate F 37.07 p < 0.0001) (Fig. 2).
Figure 2
There was a significant relationship between disgust against COVID-19 infection and increase in headache frequency (repeated measures ANOVA with disgust as covariate F 6.43 p 0.004; Fig. 2b). Patients reporting mood improvement showed reduced headache frequency (repeated measures ANOVA with mood perception as factor: F 5.43 p 0.001), independently from the region of residence (mood perception x area of residence F 0.23 p 0.91). However, the Bonferroni test among the different mood perceptions was not significant. Patients who subjectively reported a worsening of their migraine showed an objective increase in headache frequency (Repeated measures ANOVA with subjective impression of migraine severity as factor: F 35.58 p < 0.0001: Bonferroni test: got worse vs improved p < 0.01). Patients feeling migraine as a facilitating factor for infection showed a slight tendency toward frequency increase (ANOVA with perception of migraine as risk factor : F 3.59 p 0.012 Bonferroni test: n.s.).