Cynthia E. Armand, MD
This new age threat of COVID-19 has undoubtedly and reasonably caused so much chaos and concern…and it has also brought to light the continued stigma about migraine and other headache conditions. Yep, I said it, well, wrote it. In the past, I have even faced this myself: could I justify hospitalizing my patient for intravenous dihydroergotamine, fight for a single room, when our Neurology floor was, at the time, shared with terminal cancer patients? How could I fight for my patients when their condition did not lead to death? How does morbidity compare to death? These questions often plague me at night and are often the cause of the guilt I feel when I even think about helping my migraine patients in the middle of a pandemic. I mean, just the other day, my headache fellow showed me a video of a healthcare provider comically pleading to all patients without serious medical conditions to stay home (very appropriate), but at the end of the video hinted at punching a headache patient if that person had the audacity to come into the ED. Again, furthering the stigma.
Then I started to think about the whole point of medicine and the oath I took when I became a medical student and when I graduated medical school. I vowed to do no harm, to put the patient first, to prevent morbidity and mortality to the best of my ability. So, isn’t that what I am doing? Migraine is the 2nd leading cause of years lost to disability worldwide, based on the burden of disease study. This is enough for me to continue to do my best to address my patient’s valid concerns during the COVID-19 pandemic.
I’d like to think that there is room for us all: those who are fighting against primary prevention, which would lead to keeping patients out of the emergency room, and those who are fighting against life-threatening conditions. The urgency of both may differ, but both are important, making all patients with these 2 types of medical needs important.
So, to my migraine patients, feeling lost and powerless due to the tight grip that coronavirus has on our communities: you are not alone. We hear you. We are here for you. Call us. We can all fight together.