Abstract
BackgroundThe Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The aim of the present study was to investigate how the initial phase of the Covid-19 pandemic affected the hospital management of headache in Denmark and Norway.MethodsAll neurological departments in Denmark (n = 14) and Norway (n = 18) were invited to a questionnaire survey. The study focused on the lockdown and all questions were answered in regard to the period between March 12th and April 15th, 2020.ResultsThe responder rate was 91% (29/32). Of the neurological departments 86% changed their headache practice during the lockdown. The most common change was a shift to more telephone consultations (86%). Video consultations were offered by 45%.The number of new headache referrals decreased. Only 36% administered botulinum toxin A treatment according to usual schemes. Sixty% reported that fewer patients were admitted for in-hospital emergency diagnostics and treatment. Among departments conducting headache research 57% had to halt ongoing projects. Overall, 54% reported that the standard of care was worse for headache patients during the pandemic.ConclusionHospital-based headache care and research was impacted in Denmark and Norway during the initial phase of the Covid-19-pandemic.
Highlights
The Covid-19 pandemic is causing changes in delivery of medical care worldwide
A number of widely used migraine treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and calcitonin generelated peptide (CGRP) monoclonal antibodies were all scrutinized for potentially worsening the Covid-19 disease in the initial phase of the pandemic, creating uncertainty among patients and physicians [7, 8]
Anecdotal reports emerged describing a considerable drop in the number of headache patients seen in the emergency department and patients treated with injections such as greater occipital nerve block (GON) and botulinum toxin A (BTX) [9, 10]
Summary
The Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The Covid-19 was declared a pandemic by the World Health Organization (WHO) in March 2020 and led to challenges in health care systems and societies worldwide [1]. In many countries this led to a rapid shift in favor of telemedicine instead of in-person consultations [2,3,4,5]. To many patients such a change provided continuous access to care despite infection control measures, but for new-onset headache and complex chronic headache cases, this could result in suboptimal consultations without the possibility of a proper clinical examination or injection treatments [6]. It was reasonable to fear that a large number of headache patients would miss out on treatment options and would be at increased risk of personal suffering with a corresponding societal socioeconomic impact
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