Headache. What is it?
What it is:
Long COVID headache falls into three different types of headache: migraine-like, tension-type and daily persistent headaches1,2. Headache can be one of the worst experiences of Long COVID and is one of the most common neurological symptoms of this disease alongside brain fog, loss of taste and smell (aguesia and anosmia) and dysautonomia (disruption of the autonomic nervous system) and the 5th most common symptom of Long COVID after fatigue, difficulty with breathing (dyspnoea), muscle pain (myalgia) and cough1.
Typical Symptoms:
The migraine-like headache can present as throbbing on one side of the head, often accompanied by nausea, vomiting and light and sound sensitivity2.
The tension-type headache can present as a frontal headache and/or occurring across both sides of the head like a tight band.
The Long COVID daily persistent headache is very similar to a type of headache known as “New Daily Persistent Headache” (NDPH) which can resemble a migraine or tension headache but often occurs in a person who has never had a headache.
People who suffered from headache prior to getting Long COVID tend to report their Long COVID headache as being much worse. Long COVID headache can occur weeks to months after the initial SARS-CoV-2 infection1.
Who Gets It:
Long COVID headache can affect anyone who has been infected with SARS-CoV-2. There is no difference between those people who have been hospitalized or not with their COVID-19. It is more common in women over the age of 45 years.
Key Points:
- There are 3 different types of Long COVID headache – migraine-like, tension-type and daily persistent headaches.
- Long COVID headache is the 5th most common symptom of Long COVID.
- It can affect anyone who has been infected with the coronavirus SARS-CoV-2.
- The severity of COVID-19 in a person does not predict whether they will develop a headache or not.
- You do not need to have a headache when you first catch COVID to develop Long COVID headache i.e. your Long COVID headache can appear weeks to months after your initial COVID infection.
The presence of persistent headaches and migraines in long COVID highlights the enduring neurological impact of the virus, emphasizing the importance of tailored interventions and ongoing research to address the diverse challenges faced by individuals on the journey to recovery.
Long Covid The Answers
Relief:
More research is needed to work out the pathophysiology (disease causing process) behind Long COVID headaches. So until we have more information, the Long COVID headaches are managed in the same way as non-COVID headaches with similar characteristics.
These treatments fall into treatment with medication (pharmacological) and without medication (non-pharmacological).
Each treatment needs to be initiated in a way that takes into account the patient as a whole person, so that treatments do not exacerbate pre-existing illnesses or other Long COVID symptoms. Do NOT initiate medication without the supervision of an adequately trained and licensed Physician or Doctor.
NON-PHARMACOLOGICAL
Regular sleep, healthy diet, exercise (care needs to be taken in the presence of post-exertional malaise), breathing and relaxation techniques such as Yoga. Meditation and stress avoidance. External devices, which can increase or decrease nervous system activity can also be useful, the FDA has cleared some for use, most require a prescription, one called Cefaly is available over the counter4.
PHARMACOLOGICAL – (Do NOT initiate medication without the supervision of an adequately trained and licensed Physician or Doctor).
Migraine-Like Long COVID Headache – Treat the acute migraine with the following – Non-steroidal Anti-inflammatory Drugs (NSAIDs) eg Ibuprofen (Advil), High-dose Asprin; Tryptans are second line for acute migraine and when prescribed with an anti-nausea medication such as metoclopramide or domperidone, tend to work better. The FDA has approved two new classes of oral drugs for acute migraine – Ditans (lasmiditan) and Gepants (ubrogepant and rimegepant)5.
Preventive (Prophylactic)medications include tricyclic antidepressants such as amitryptiline or nortryptiline, Botox, Beta-Blockers, antihypertensives and newer calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs)6.
Tension-Like Long COVID Headache – Treat acute headache as follows – NSAID followed by combined preparations including caffeine
Prophylactic medications – Tricyclic antidepressants, venlafaxine or mirtazepine.
Daily Persistent Long COVID Headache – Like the NDPH this is notoriously difficult to treat. Medications used in migraine and tension-type headaches can be tried, there has also been some relief with the use of glucocorticoids. For people with Long COVID, we have found no documentation of treatment for this type of headache with the new classes of migraine medication. More research is needed in this group of patients.
Migraine Doctor Directory
Migraine Resources & Support – North America
Credible Sources of Information:
1. Tana, C., Bentivegna, E., Cho, SJ. et al. Long COVID headache. J Headache Pain 23, 93 (2022). https://doi.org/10.1186/s10194-022-01450-8 – good summary of scientific evidence about Long COVID headache.
2. How COVID-19 Headaches are different from others – and how to manage them, by Tara Haelle, National Geographic pub 23rd Sept 2022 – Great article which gives a good overview in non-medical terms of Long COVID headache.
3. The American Migraine Foundation – great website with lots of information about all sorts of headache including Long COVID headache. Also has a ‘find a doctor’ directory for Physicians that manage headache in North America (the USA & Canada).
4. “Headache: A Common Long COVID Syndrome” – article on the Weill Cornell Medicine website with an accompanying podcast – Good interview with Professor Matthew Robbins MD Associate Professor of Neurology and Associate Attending Neurologist at Weill Cornell Medicine.
5. Tzankova V, Becker WJ, Chan TL. Diagnosis and acute management of migraine. CMAJ [Internet]. 2023 [citado el 19 abril 2023]; 195 (4): E153–8. – Good recent, readable update.
6. Tzankova V, Becker WJ, Chan TL. Pharmacologic prevention of migraine. CMAJ. 2023 Feb 6;195(5):E187-92. Good recent, readable update.