Abstract text (incl. figure legends and references)

Question: We aimed to compare the clinical characteristics of migraine, use of prophylaxis, and psychological symptoms between patients who referred to our Headache Centre before the COVID-19 pandemic and those who were evaluated during the pandemic, with a further distinction between the first phase and the prolonged second phase.

Methods: We studied 418 adolescents with migraine (m.a. 14±1.7; 110 M and 308 F). Based on the pandemic period, patients were grouped into 'Pre Covid' or 'Covid'. Moreover, the second group was divided into 'Covid 1' (March to October 2020, characterised by lockdown) and 'Covid 2' (November 2020 to January 2022, characterised by prolonged restrictions). Patients were grouped into: (1) high frequency (weekly to daily episodes) and low frequency (≤3 episodes per month); (2) mild and severe pain; (3) need for prophylactic treatment or not. The PHQ-9 and GAD-7 questionnaires were used to assess anxiety and depression symptoms.

Results: We did not find a significant difference in migraine frequency between the "Pre Covid" and "Covid" periods (p=0.295). In the "Covid 2" period, frequency of the attacks was increased, compared to both the "Pre Covid" period (p=0.038) and the "Covid 1" period (p=0.005). Furthermore, more patients needed prophylactic treatment in the 'Covid' period, especially in the 'Covid 2' period (p=<0.001), than in the 'Pre Covid' period (p=<0.001). Our patients showed higher levels of anxiety and depression during the 'Covid' period (GAD-7, p=0.013 and PHQ-9, p=<0.001), especially during the 'Covid 2' period (p=<0.001).

Discussion: Our results show a long-term negative impact of the Covid-19 pandemic on clinical parameters and psychological symptoms of adolescents with migraine. Considering the relationship between migraine severity and emotional symptomatology, our results suggest that monitoring the emotional status of pediatric patients with migraine is mandatory in the near future of COVID-19 pandemic.