- A headache associated with COVID-19 can feel like a tension headache or a migraine.
- Some patients can also experience persistent daily headaches after recovering from an acute COVID-19 infection.
- Lifestyle changes and certain medications may treat a COVID headache to an extent.
Headaches are one of the most common symptoms of COVID-19. But are they different from other types of headaches?
COVID headaches could manifest differently among individuals, according to Igor Koralnik, MD, chief of neuroinfectious diseases and global neurology at Northwestern Medicine. Headaches can be similar to a constant tension headache or a throbbing pain like a migraine attack.
About 70% of the patients at the Neuro COVID-19 Clinic at Northwestern Memorial Hospital experience headaches associated with the coronavirus, Koralnik added.
According to a 2020 study, patients with a pre-existing primary headache experience COVID headaches more frequently than those without. Dehydrated patients also reported more frequent COVID-related headaches. Coughing or head movement may increase the intensity of the headache as well.
Erin McConnell, MD, an internal medicine physician at the post-COVID recovery program at The Ohio State University Wexner Medical Center, told Verywell that some of her patients experience new or worse migraines after an acute COVID-19 infection.
“This is most likely multifactorial as many patients with [long COVID] are already suffering from fatigue and non-restorative sleep, both of which can trigger migraine headaches,” she said.
Why Would COVID Cause Headaches?
Survivors of the 1890 flu pandemic had experienced post-infection symptoms months to years after the pandemic ended. One of the documented complications was a persistent, daily headache. Researchers suggested that the many similarities between the 1890 pandemic and the current pandemic mean that headache of a similar nature is a possible consequence of COVID-19.
“It would be fair to speculate that new-onset headache would be related to the viral illness itself, since COVID tends to present with flu-like symptoms,” McConnell said.
Many people develop a headache during the course of the infection that eventually goes away when they recover. In some cases, the headache occurs long after the initial infection.
“The headaches with COVID can last as long as the acute illness, or as long as weeks to months, especially in those who develop them as part of their long COVID manifestation,” McConnell said.
Koralnik, who recently led a study on long COVID symptoms, said that headaches caused by viral illnesses generally don’t last as long as they do in long COVID patients.
There’s no conclusive data yet, but it’s possible that post-COVID headache is caused by systemic inflammation during the acute phase of COVID-19 or related to constant immune activation.
The immune system could have been “confused by the virus to think that normal components of the brain need to be attacked,” Koralnik said. Inflammation and changes in micro blood flow around the brain might be able to trigger post-COVID headaches.
How Is COVID Headache Treated?
Treatment recommendations for long COVID headaches have been similar to how physicians treat other chronic headaches, McConnell said, which include adequate sleep, proper hydration, regular meals, and keeping stress to a minimum.
Using over-the-counter painkillers too frequently may lead to medication overuse headaches, so it’s best to discuss with a healthcare provider about potential treatments.
“If they are severe enough or frequent enough, we may start preventative medications such as beta-blockers, anti-epileptics, or tricyclic anti-depressants, which are meds that we commonly use to prevent chronic daily headaches,” McConnell said.
Like all instances of neurological symptoms, diagnosing any headache must be based on a thorough medical history and neurological examination, Koralnik said. Sometimes, the headache does not respond to over-the-counter medications and NSAIDs.
If no other causes are found, low doses of nortriptyline, a type of antidepressant, at bedtime are used to prevent and treat headaches, he added.
At present, more research is needed to understand how to treat post-COVID symptoms effectively. Experts recommend getting vaccinated and boosted against COVID-19 to avoid severe outcomes from the disease.
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