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The bigger picture

Mental stress & headache in times of Covid

Rarely has a saying been more apt than now. Covid is a headache on so many levels. The contact restrictions are causing profound distress. Fear and uncertainty are everywhere. Will it ever go away? When will I get my life back? These are questions we are all asking ourselves.

Lockdown is hitting students extra hard. Academic disciplines with a practical focus (healthcare, for example) or that require personal interaction (the humanities, education studies) face significant challenges. In science subjects, online alternatives to lab practicals and field excursions cannot come close to the real thing. Students learning to be educators are asking themselves how and when they will be able to get the classroom experience their degrees require, and which is such an essential and eagerly anticipated part of becoming a teacher.

Feeling overwhelmed is the new normal

Ask any student what their life is like right now and you’re likely to hear the same thing: students and staff are equally overwhelmed with the situation. Seminars and exams have suddenly morphed into homework assignments, to be completed by hastily thrown together teams of people who may never even have met before in real life. The fact that some fellow students display an extremely "individual" working style makes the projects more difficult. Not uncommonly, a few hard workers end up doing all the work to get assignments submitted on time.

With university libraries closed or only accessible by the hour, some facilities have no arrangements in place to give a large student population access to the resources they need. Students get into scheduling difficulties through no fault of their own. Some find themselves forced to buy material they originally intended to borrow in order to move forward at all, putting a strain on their finances that can only be mitigated by parental help.

Speaking of finances: lockdown is stopping many students from doing their part-time job to get by financially, or just to earn money for little luxuries like going to the gym, theater, cinema or concert (the fact that all these things are closed anyway is kind of beside the point and not much consolation). No wonder anxiety about the future is so widespread among students right now. Some are having panic attacks, insomnia and depression for the first time in their lives.

Worrying data

Research into the mental health impacts is now available from some of the European countries hit hardest by the first wave and the associated lockdown.

A survey among students and university administration staff at the University of Milan, Italy uncovered an increased incidence of sleeplessness and deterioration of sleep quality in both groups. Respondents said they also took longer to fall asleep. The authors additionally report an increase in anxiety, panic attacks and depression and a significant deterioration in mental and emotional well-being. The impacts were greater among students than university staff, and women were more severely affected than men.

The findings of a Spanish study in 2500 students and university staff are strikingly similar. Again, there was a significant uptick in stress perception, anxiety, and symptoms of depression. Reported stress levels were particularly high among students in the humanities and social science departments. Students in STEM programs were somewhat less affected. In this study, too, the impacts were apparent across the board but more pronounced among students than staff.

Meanwhile in France, a nationwide study by Wathelet and colleagues reveals some very concerning effects of pandemic restrictions, including a significantly increased prevalence of mental distress symptoms such as panic attacks, stress, depressive symptoms and suicidal ideation. Participants said these mental health impacts were mainly caused by financial worries, social isolation, a stressful housing situation, and uncertainty due to a feeling of being inadequately informed. The authors highlight the fact that, despite the increase in mental health issues, people were less likely to seek or receive professional help in the pandemic situation.

Comparatively little research is available from German-speaking countries. A University of Munich (LMU) study evaluating questionnaires distributed among Bavarian universities again found an increase in mental stress and psychological issues. The authors say a major reason is because closure of sports facilities means students currently have no physical outlet to release their stress and get rid of negative energies.

The signs are all there: mental health issues are soaring in the student population as the pandemic unfolds, with more and more young people sleeping badly, waking up exhausted, unable to concentrate and plagued by headaches and migraine attacks far more than usual. Otherwise healthy people seem to be getting headaches more often in the pandemic situation.

What can you do?

There’s no need to resign yourself to headache and migraine attacks as an inevitable consequence of lockdown and the pandemic. Especially in the face of these extraordinary challenges, the best approach is to stick even more closely to the central premises of headache prevention. The main one is to maintain a regular routine and work relaxation into your schedule. So, especially if you’re working from home, it is key to give structure to your new, unfamiliar day and embrace all the lifestyle habits that help prevent headaches (regular meals, staying hydrated and a healthy sleep rhythm) even in these tense times. The headache app provides lots of useful services you can try.

In addition, don’t neglect to give yourself some me-time for relaxation. Especially now, it may feel tempting to spend all day working or playing in front of a screen and avoid the cold and wet outdoors as much as possible. But from a headache prevention point of view, these are unhealthy lifestyle choices that could land you in trouble. The gym is closed? Step outside and move your workout to the open air. It gets your circulation going, improves your oxygen supply and helps to keep your gray cells fit and primed for headache-free hours of studying. Migraineurs in particular stand to benefit from off-screen time – the nerve we need for seeing (optic nerve) is one of the most energy-hungry parts of the body. There are loads of creative new ideas around right now for ways to enjoy some off-screen moments. The current baking craze is ideal for headache sufferers. A freshly baked loaf of homemade bread is the perfect nourishment for a day spent working from home.

If aprons and ovens are not your thing, try something else. Calligraphy, crafts, letter-writing, creating the perfect playlist in anticipation of summer – social media channels these days are full of creative ideas to beat your quarantine blues. Let’s just hope the “old normal” comes back soon!

  • 1. Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. J Clin Neurosci. 2020 Jul;77:8-12. doi: 10.1016/j.jocn.2020.05.017. Epub 2020 May 6.

    2. Correia AO, Feitosa PWG, Moreira JLS, Nogueira SÁR, Fonseca RB, Nobre MEP. Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. Neurol Psychiatry Brain Res. 2020 Sep;37:27-32. doi: 10.1016/j.npbr.2020.05.008.

    3. Ibrahim W. Neurological manifestations in coronavirus disease 2019 (COVID-19) patients: a systematic review of literature. CNS Spectr. 2020 Oct 21:1-12. doi: 10.1017/S1092852920001935.

    4. Khateb M, Bosak N, Muqary M. Coronaviruses and Central Nervous System Manifestations. Front Neurol. 2020 Jun 23;11:715. doi: 10.3389/fneur.2020.00715.

    5. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Apr 10. doi: 10.1001/jamaneurol.2020.1127.

    6. Marelli S, Castelnuovo A, Somma A, Castronovo V, Mombelli S, Bottoni D, Leitner C, Fossati A, Ferini-Strambi L. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2021 Jan;268(1):8-15. doi: 10.1007/s00415-020-10056-6.

    7. Odriozola-González P, Planchuelo-Gómez Á, Irurtia MJ, de Luis-García R. Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res. 2020 Aug;290:113108. doi: 10.1016/j.psychres.2020.113108.

    8. Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol. 2020 Nov;16(11):636-644. doi: 10.1038/s41582-020-0398-3.

    9. Schlichtiger J, Brunner S, Steffen J, Huber BC. Mental health impairment triggered by the COVID-19 pandemic in a sample population of German students. J Investig Med. 2020 Dec;68(8):1394-1396. doi: 10.1136/jim-2020-001553.

    10. Wathelet M, Duhem S, Vaiva G, Baubet T, Habran E, Veerapa E, Debien C, Molenda S, Horn M, Grandgenèvre P, Notredame CE, D'Hondt F. Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic. JAMA Netw Open. 2020 Oct 1;3(10):e2025591. doi: 10.1001/jamanetworkopen.2020.25591.

    11. Wenting A, Gruters A, van Os Y, Verstraeten S, Valentijn S, Ponds R, de Vugt M. COVID-19 Neurological Manifestations and Underlying Mechanisms: A Scoping Review. Front Psychiatry. 2020 Aug 21;11:860. doi: 10.3389/fpsyt.2020.00860.

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