The alarm goes off and you turn over. Before you are even fully awake you can feel it. The tell-tale tenderness of the eyes, the pressure in the left side of your head, the way the normally enjoyable radio station your alarm is set to suddenly sounds like nails on a chalkboard. You have woken up with a migraine and it’s far from the first time. Rolling to your back you open your eyes. All the lights are off but the glare through the closed blind is enough to make you squeeze your eyes shut again. You put your hands over your eyes, finally experiencing total darkness, wishing you could stay there all day. Unfortunately, you are a graduate student in the era of Covid-19 and your day is chock full of digital work.
The academic world in which you take part went through a major change in late February, less than a month and a half before you were set to graduate from your undergraduate degree. The world itself had begun to change back in December, on the other side of the world. In the last few days of 2019, the World Health Organization became aware of a new disease spreading rapidly in Wuhan, China, a central city with a population of over 11 million people. What was originally reported as virulent cases of pneumonia were identified as SARS-CoV-2 on January 7th and then shared with the public on January 12th, 2020. The first case was confirmed in Canada on the 25th of January, 2020 in a Toronto man who had recently returned from Wuhan.
The deadly respiratory virus was traced back to a market in China where it is believed to have jumped the species from bats to humans. While it is one of six strains of coronavirus that have presented in humans, the immunological naïveté the world presented in the face of this strain resulted in near-immediate action from organizations like the World Health Organization. The strain of the virus is able to survive on surfaces for multiple days and can survive in the air for several hours, but can be killed with soaps and detergents. This is a fact that crosses your mind multiple times a day and is the main reason for the near constant smell of alcohol-based disinfectant no matter where you go. Covid-19 symptoms are similar to those of the flu or a severe cold. Though they differ from person to person, symptoms often include cough, shortness of breath, fever, weakness, body aches, loss of smell and taste, and gastrointestinal issues. Despite the severity of the symptoms, not all cases are symptomatic. Those shown to be most at risk for contracting the disease include those over 60 years of age, those with chronic illnesses, the immunocompromised, and those living with obesity.
The ease of transmission, populations at risk and the steadily rising cases eventually lead to the world shutting down. When your most eccentric friend began talking about quarantine and martial law occurring in Canada to control cases, you rolled your eyes at him. Unfortunately, it was not long before you were issuing a partial apology. On March 15th, 2020 Trent University announced its plan to close all but essential services by the end of the following day. This came as no surprise to you, as the day before, the public schools and the dance studio where you teach closed their doors as well. Before you were even able to make arrangements to return to your parents’ home for the closure period, the province of Ontario declared a State of Emergency on March 17th, 2020. Not long after that, you and your cat were moved back in with your parents and you were finishing your undergraduate degree via online classes at a desk in an unfinished upstairs guest room.
It is now eight months later, October, in a digital first world. Anyone that can is still encouraged to work from home online, and students are very much included. Your first semester of graduate school is completely online, and your second semester is likely to be more of the same. While the past eight months have been full of the unprecedented, there was one aspect of an online world that you did not anticipate.
You and migraines go way back. You got your first at age seven, they then became rather common by age twelve, and then could be officially considered chronic by age seventeen. Chronic migraine considered a clinical brain disorder characterized by a minimum of fifteen headache days per month. Studies estimate that at least 1% of the world’s population suffers from chronic migraines, and as a result, the condition ranks among the top 40 most debilitating conditions. For you, debilitating is definitely the right word. Every aspect of your life has suffered due to migraines at least once. From sports, to grades, to relationships, to hobbies, near constant migraines have gotten in the way or completely ruined them. They usually last at least two days, with the longest lasting a record-breaking sixteen days. At age 22 the story is very much the same. Throughout your university career you have required accessibility accommodations for chronic migraine and its two most common comorbidities, depression and anxiety, due to the difficulties they cause regarding reading comprehension and while using technology. Your personal life consists of friends you see too little because you seem to always have a migraine whenever you have something planned, and you have no partner since the last responded to your chronic illness with nothing but anger. Outside of school you balance two jobs, one as an online teaching assistant, and the other as a dance instructor. More often than not, you are working with a low-grade headache at the very least. While this causes problems in the studio while you are struggling to make yourself heard over the music, the more pressing issue concerns what has become known as “the new normal.”
Working from home replaced the traditional rat-race for many people. Any job that did not require functions that could not be done remotely or did not match the government definition of critical service, transferred to an online format. This included most office jobs, call-centres, dance studios, and educational institutions. While many found this transition positive, as a way to spend more time with family or get work done in a more relaxed environment, for you, the transition to online schooling was an anxiety inducing shift. You have taken online classes before, actually an online class was how you found the woman who would become your master’s supervisor, but all classes? Not a good idea. While not formally diagnosed with any type of learning disability, you know you have issues with attention. Considering your abilities to either hyperfocus or be distracted like a cat surrounded by shiny things, you knew finishing those last few assignments and exams would be an issue. The bigger issue, however, was what you had to look at all day – your laptop screen.
The light from the laptop screen has long been a problem for you. When requesting extensions on assignment deadlines, the most commonly cited issue is how hard it is for you to look at your screen. When you have a migraine, looking at the faintly glowing rectangle feels like an implement is being pushed above your eyeball into your brain. The pain radiates through the left side of your head, the most common site of your migraines, and causes you to clench your jaw. This is actually a well-known migraine-related phenomenon known as photophobia or photosensitivity. Clinically defined as “an abnormal an extreme sensitivity to light,” photophobia is common for those who experience migraines, both as a trigger and as a source of exacerbation. Over the years, you have noticed that this is very accurate in your case. Bright lights cause physical pain, flashing or flickering lights or screens occasionally cause nausea, even sunlight gives you migraines, giving further credibility to your preference of rainy days. The issue with school shifting to fully online, is that there is no break from your screen when you need one. One of your coping methods is to take notes in a notebook instead of on your laptop when attending an in-class lecture, sitting in the back and avoiding looking directly at the screen of course. Online lectures remove this possibility. Even though you take notes in a notebook almost exclusively because of the tendency Zoom has to take over the screen, you still have to use the screen. With classes now online, participation changes as well. Usually, you choose not to bring your laptop to seminars, finding that writing in a notebook is more conducive to a discussion scenario. Discussion boards became the replacement for round-table discussions in a seminar room. While not a huge change for many, the increased screen time had an impact on you.
Luckily for you, not only do you have migraines, but you have a rare kind. Brainstem aura migraines, also known as basilar-type migraines, are characterized by two of your most problematic symptoms – difficulty with both reading comprehension and speech. Growing up in a family of readers and having reading as a favourite pastime since you learned the skill, the reading required in academia never phased you. That is until the words started to jumble. When a migraine is coming on or while you are experiencing one you experience something similar to dyslexia, you call it literary aphasia. Your reading pace slows down and you get the feeling that you are looking at the words without actually seeing or understanding them. Your own writing appears non-sensical upon review and the writing of others seems incomprehensible no matter how simple it may be. This literary aphasia affects the act of writing as well. Whether typing or writing longhand, you cannot seem to make the words appear. Sometimes you find it difficult to form a sentence or even a thought. Other times, words, including their spelling and definitions, seem to vacate your brain completely. When speaking, the same happens. If and when you are able to form a sentence to vocalize, it often comes out of you slowly, with a stutter. While speaking can be avoided in most situations, reading and writing are pillars of academia and your occasional inability to do these simple things has brought you to the brink of tears more than once.
The question becomes, what do your migraines and going to university online have in common? The answer is lots of electronic screens, reading and writing. In the interest of ease and accessibility, physical textbooks have been put aside, and nearly every reading is accessible online. Though this cuts down on the costs of university, it causes a host of issues for those with vision issues and migraines. If a work is scanned from a physical text and posted, the images are often grainy and blurry, and the size of the text cannot be altered. Certain web sources have inaccessible colour schemes, and even if the source is easy to read in every possible way, reading digital text on a screen does strain the eyes. These go without the obvious issue that the reader, you, a migraine sufferer, is spending many extra hours staring at a computer screen. These extra hours of screen reading, not to mention the time spent attending online lectures, conducting research, and writing, add to the frequency of your migraines.
Since the beginning of the switch to online learning, your migraines have increased to approximately one per week. You understand the need for the switch, and you would never risk the lives of others just because your chronic illness is affected, but it does wear on you. Despite the four pills you take every day for migraine prevention, you experience pain daily. After about an hour on Zoom, your left hand has most likely started rubbing your temple, the Medic-Alert bracelet on that wrist still feeling foreign when it moves. You had to begin wearing it when you started the newest medication trial, because it affects your heart rate. The search for treatment currently seems like the most pointless mission. The first thing doctors tell you is to identify your triggers and avoid them. This advice is frustrating at best when you have no option but to engage with your migraine triggering laptop for hours upon hours a day. You have dealt with years of hearing about how you are too young to have this much pain and chronic issues, with no suggestion of how to remedy the situation. Now, beginning the ninth month of the Covid-19 pandemic, you are armed with heart medication, ineffective breakthrough pain medication, ice packs, and the bedtime of a geriatric narcoleptic. While you understand the need for these precautions, the increase in your migraines is a symptom of the Covid-19 pandemic no one expected, and you look forward to the day when you can begin to reduce your screen time and safely continue your degree in person.
American Migraine Foundation. “Photophobia (Light Sensitivity) and Migraine.” American Migraine Foundation. December 21, 2017.https://americanmigrainefoundation.org/resourcelibrary/photophobia-migraine/.
Bronca, Tristan. “COVID-19: A Canadian timeline.” Canadian Healthcare Network. Last modified April 8, 2020. https://www.canadianhealthcarenetwork.ca/covid-19-a-canadian-timeline.
Chaplin, Steve. “COVID-19: a brief history and treatments in development.” Prescriber 31, no. 5 (2020): 23-28. https://doi.org/10.1002/psb.1843.
“Coronavirus disease (COVID-19).” Government of Canada. September 30, 2020. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html.
“Coronavirus disease (COVID-19): Symptoms and treatment.” Government of Canada. October 30, 2020. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.html.
“Coronavirus disease (COVID-19): Working remotely.” Government of Canada. June 22, 2020. https://www.canada.ca/en/government/publicservice/covid-19/working-remotely.html
“COVID-19: Government service changes and public closures.” Ontario. Last modified October 7, 2020. https://www.ontario.ca/page/covid-19-government-service-changes-and-public-closures.
DeClerq, Katherine. “Ontario to close all publicly funded schools for 2 weeks after March break due to COVID-19.” CTV News. March 12, 2020. https://toronto.ctvnews.ca/ontario-to- close-all-publicly-funded-schools-for-2-weeks-after-march-break-due-to-covid-19-1.4850653
Frost, Andrea (A Frost Dance Experience Dance Studio). “We have always made the health of our staff and families a priority. We need to do our part in reducing the spread of the coronavirus. We have made the difficult decision to suspend classes until April 6th…” Facebook, March 16, 2020. https://www.facebook.com/AFrostDance/photos/a.1320150591360593/36307572369665 72/.
Groarke, Leo. “COVID-19 Update: Trent moving to a reduced campus presence with essential on-campus services only.” Trent Forward: Our response to COVID-19. March 15, 2020. https://www.trentu.ca/coronavirus/news-events/26629.
“Migraine and Stroke.” Stroke Association. November 2017. https://www.stroke.org.uk/sites/default/files/migraine_and_stroke.pdf
Parodi, Italo Carlo, Maria Gabriella Poeta, Andrea Assini, Erika Schirinzi, and Paola Del Sette. “Impact of quarantine due to COVID infection on migraine: a survey in Genova, Italy.” Neurological Science 41 (2020): 2025-2027. https://doi.org/10.1007/s10072-020-04543- x.
Weatherall, Mark W. “The diagnosis and treatment of chronic migraine.” Therapeutic Advances in Chronic Disease 6, no. 3 (2015): 115-123. DOI: 10.1177/2040622315579627.
 Steve Chaplin, “COVID-19: a brief history and treatments in development,” Prescriber 31, no. 5 (2020): 23.
 Chaplin (2020): 23.
 Tristan Bronca, “COVID-19: A Canadian timeline,” Canadian Healthcare Network, last modified April 8, 2020, https://www.canadianhealthcarenetwork.ca/covid-19-a-canadian-timeline.
 Chaplin (2020): 23.
 Chaplin (2020): 23; Bronca 2020.
 Chaplin (2020): 24.
 “Coronavirus disease (COVID-19): Symptoms and treatment,” Government of Canada, September 30, 2020, https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.html.
 Chaplin (2020): 24.
 “Coronavirus disease (COVID-19),” Government of Canada. September 30, 2020, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html.
 Leo Groarke, “COVID-19 Update: Trent moving to a reduced campus presence with essential on-campus services only,” Trent Forward: Our response to COVID-19, last modified March 15, 2020, https://www.trentu.ca/coronavirus/news-events/26629.
 Katherine DeClerq, “Ontario to close all publicly funded schools for 2 weeks after March break due to COVID-19,” CTV News, March 12, 2020, https://toronto.ctvnews.ca/ontario-to-close-all-publicly-funded-schools-for-2-weeks-after-march-break-due-to-covid-19-1.4850653.; Andrea Frost (A Frost Dance Experience Dance Studio), “We have always made the health of our staff and families a priority. We need to do our part in reducing the spread of the coronavirus. We have made the difficult decision to suspend classes until April 6th…” Facebook, March 16, 2020, https://www.facebook.com/AFrostDance/photos/a.1320150591360593/3630757236966572/.
 “COVID-19: Government service changes and public closures,” Ontario, last modified October 7, 2020, https://www.ontario.ca/page/covid-19-government-service-changes-and-public-closures.
 Mark W. Weatherall, “The diagnosis and treatment of chronic migraine,” Therapeutic Advances in Chronic Disease 6, no. 3 (2015): 115, DOI: 10.1177/2040622315579627.
 Weatherall, (2015): 115.
 Italo Carlo Parodi, Maria Gabriella Poeta, Andrea Assini, Erika Schirinzi, and Paola Del Sette, “Impact of quarantine due to COVID infection on migraine: a survey in Genova, Italy,” Neurological Science 41 (2020): 2025-2027, https://doi.org/10.1007/s10072-020-04543-x.
 “Coronavirus disease (COVID-19): Working remotely,” Government of Canada, June 22, 2020, https://www.canada.ca/en/government/publicservice/covid-19/working-remotely.html.
 American Migraine Foundation, “Photophobia (Light Sensitivity) and Migraine,” American Migraine Foundation, December 21, 2017, https://americanmigrainefoundation.org/resource-library/photophobia-migraine/.
 American Migraine Foundation, 2017.
 “Migraine and Stroke.” Stroke Association. November 2017. https://www.stroke.org.uk/sites/default/files/migraine_and_stroke.pdf