Why are some people getting more frequent migraine attacks?

We know from a recent poll that many people with migraine have had an increase in their attacks since the pandemic triggered the lockdown. This may be due to a number of factors.

The brain of a person with migraine is always sensitive to change because of the genetic link with this condition. The changes may be in our internal environment or our external environment. The lockdown has caused many changes in our daily lives.

Sleep routines may have altered with the change to working from home and with schools being closed. Anxiety, stress and low mood may contribute to restless sleep.

Mealtimes may also have changed with the temptation to snack, cravings for comfort food and the simplicity of takeaways leading to a change in the balance of carbohydrates, fat and protein. Alcohol and caffeine intake may have increased.

Some people have reacted to our confinement by exercising more than usual where others may be finding their lives are more sedentary.

So all these changes can impact and irritate the brain of a person with migraine. Trying to control them as much as possible can be helpful. Routine is a key word.

1. Stick to a routine sleep pattern wherever possible -go to sleep at the same time and wake at the same time every day if possible.

2. Once awake in the morning, try to get outside into daylight for your exercise even if this is just a simple walk round the block.

3. If doing exercise, remember little and often is better than an occasional full-on 2 hour workout. Go gently at the start, eat and drink to maintain blood glucose levels and hydration and stretch out gently afterwards.

4. Make sure you are eating regularly every 3-4 hours and introduce a bedtime snack, especially if you eat your main meal in the early evening. Think about the balance between the food groups and try and reduce Carbohydrates like sugar, cakes, biscuits, fizzy drinks, starchy foods like potatoes, rice, and wheat products as in bread, pasta and pizza. Increase the proportion of protein and fat by altering the relative portion sizes. Increase the amount of vegetables you eat -you can’t have too many! Snacks of nuts, seeds, berries and dairy products (if you are not vegan) may be useful.

5. Mindfulness, relaxation breathing exercises -slow exhalations, yoga stretches and other techniques like expressive writing, gratitude journaling and meditation can all help reduce anxiety and improve restorative sleep quality.

6. Beware of caffeine and alcohol. It is tempting to have these to relieve our stress or perk us up but both are not helpful for sleep quality and may result in triggering a migraine attack.

7. Be sure to have a good supply of the usual medications that you take to help your acute migraine and also your preventative medications if applicable. GP surgeries are still open although they may be operating via video consultations or telephone. They are still there for you for advice and prescriptions.

8. If you have not tried them already, it may be worth trying one, two or three of the supplements which have some evidence of benefit in reducing migraine: Magnesium, Riboflavin(Vitamin B2) and /or Co-enzyme Q10. See our factsheet for more details.

9. Get in touch for an appointment with one of our headache specialist doctors for a more detailed personal plan to help you reduce the impact of your migraines.

10. Avoid reading, watching or listening to depressing or anxiety-provoking news stories which can often circulate widely on social media too. Find a trusted news source and only update yourself once a day -preferably not just before going to bed. It is very easy to catastrophise and that will raise stress hormone levels which in turn can make migraine more likely.

What medication to avoid if you have COVID-19 infection

There has been some discussion about the use of Aspirin, Ibuprofen, Naproxen and other NSAIDs during COVID-19 active infection. The evidence has been debated, but the consensus is to be on the safe side.

If you have symptoms of the virus and need to take a painkiller for headache, avoid these and stick to Paracetamol. The headache the virus causes may be different from your usual migraine but it does seem to respond to Paracetamol which will also help to control high temperatures.

Codeine alone or in combination products like Co-codamol and Migraleve etc and opiates like Tramadol are always best avoided by people with migraine.

It is perfectly safe to take triptan medication and your usual preventative medication.

Preventative Treatments which are not available and the alternatives

Anything which needs a face to face consultation is not possible at the moment due to the infection risk to patients and staff and this has largely affected people who need Onabotulinum toxin injections (Botox) or Great Occipital Nerve Blocks.

There are alternative preventers under the headings
i.Medication – various
ii.Neuro-modulation devices – Cefaly Dual, sTMS mini
iii.Injections -anti-CGRP medications

Please listen to our podcast Heads Up for more details about these.

The anti-CGRP injections are self-administered at home and can be prescribed by our Doctors. As we are a charity with no NHS funding, we do have to charge for these. Please speak to Reception about an appointment and about costs if you are interested in trying one of these (call us on 020 7251 3322 or 020 7251 7800).

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This information is provided as a general guide only and is not a comprehensive overview of prescribing information. If you have any queries or concerns about your headaches or medications please discuss them with your GP or the doctor you see at the National Migraine Centre.