Headaches after COVID-19: What You Should Know

In recent history, perhaps one of the most impactful occurrences across the planet has been the Coronavirus disease (COVID-19) pandemic.

A highly contagious illness caused by the SARS-CoV-2 virus,  COVID-19 was first noted in Wuhan, China, in December 2019. Due to rapid infection rates, COVID-19 was declared a global pandemic by the World Health Organization (WHO) in March 2020. Most people infected by COVID-19 and its variants suffer mild to moderate symptoms; however, others develop more severe reactions, leading to over 6 million fatalities worldwide between 2020 and mid-2022. 

Headache — a common feature of acute illnesses, including viral infections — has likewise been associated with the COVID-19 infection, along with other coronavirus symptoms such as cough, fever, tiredness, and loss of smell and taste. Many people who tested positive for COVID-19 in fact reported headache as one of their earliest signs of infection, particularly people with a prior history of regular headaches or migraine.

Recovery and Post-COVID Syndrome

Recovery from COVID-19 varies from person to person — typical recovery takes two weeks but, in more severe cases, may take longer.

Some people who’ve shed the virus continue to have lingering headache discomfort, as well as one or more other persistent symptoms (fatigue, difficulty breathing, joint pain, chest pain, brain fog, loss of taste and/or smell, and sleep issues). This condition is known as post-COVID syndrome, and people who experience it are often referred to as COVID long-haulers.

What percentage of COVID patients experience ongoing symptoms? Studies vary widely — some suggest that just 6% will have elements of post-COVID syndrome, while others find that number could be as high as 70%. It’s not known why certain people develop this syndrome, but research shows that at higher risk are people over 50 who experienced more severe COVID-19 symptoms and who also have an underlying medical condition, especially cardiopulmonary issues and diabetes. But post-COVID syndrome is not exclusive to that group —  anyone infected by the coronavirus may potentially develop post-COVID syndrome.

Post-COVID Headache

Unfortunately, many people with post-COVID syndrome report a daily, new and persistent headache. In some patients, these post-COVID headaches last just a few days beyond their negative test result — but in others, it may carry on for months before being treated effectively. According to the American Migraine Foundation, most people with post-COVID syndrome will be rid of their post-COVID headache within 2 months; however, in more extreme cases, about 8% reported persistent headaches up to 6 months after testing negative. As noted, studies suggest that people already prone to headache and migraine prior to infection are also more likely to be affected by post-COVID headaches as well.

According to Dr Deena Kuruvilla, neurologist and headache specialist at Westport Headache Institute, the most common type of post-COVID headache is migraine, a unilateral throbbing pain, often accompanied by nausea, vomiting, and sensitivity to light and/or sound. She also notes that, besides head pain, COVID-19 can manifest with other neurological symptoms, including dizziness, loss of smell and/or taste, strokes, and seizures. 

What causes these post-COVID headaches? Current hypotheses include:

• The SARS-CoV-2 virus may remain active in the body even after testing comes back negative, continuing to spur symptoms.
• The immune system continues to create an immune response, even after the virus has left the body. 
• COVID-19 infection may result in long-term damage to the brainstem, causing severe headaches.
• The SARS-CoV-2 virus may interact with CGRP receptors that are known to play a role in triggering migraine attacks. Alternatively, the viral antibodies which remain in the body post-COVID infection may interact with these CGRP receptors, explaining why symptoms remain after a negative test result.

Most people with post-COVID syndrome will be rid of their post-COVID headache within 2 months; however, in more extreme cases, about 8% reported persistent headaches up to 6 months after testing negative. Studies suggest that people already prone to headache and migraine prior to infection are also more likely to be affected by post-COVID headaches as well.

‍Studies of Post-COVID Headache

The neurological impact of COVID-19 is still largely unknown but, as noted, studies suggest a link between SARS-CoV-2 infection and more frequent or severe headaches and migraine. 

Let’s look at a case-control study in Spain, where three different post-COVID headache patients illustrate the different possible effects:

• Patient #1 experienced episodic migraine (15 or less migraine attacks per month) prior to getting COVID-19. After their initial COVID-19 diagnosis, they reported an increase in their migraine frequency, lasting 6 months. This was identified as migraine chronification — post-COVID headache converted their episodic migraine into chronic migraine (15 or more migraine attacks per month).
• Patient #2 had no previous history of headache or migraine. Following a mild COVID-19 infection that included headache as an initial symptom, headaches persisted for 5 more months. This was characterized as a long-lasting COVID headache.
• Patient #3 had no headaches during the acute phase of COVID infection. However, after respiratory symptoms improved, headaches began, continuing for another 5 months until patient #3 sought medical attention. This was considered a delayed-onset COVID headache.

In an online survey of the effects of COVID on people with a history of migraine, 60% had an increase in migraine frequency, 16% showed a decrease in frequency, and 10% went from episodic to chronic migraine. 

Treating Post-COVID Headache

Research is underway to better understand post-COVID headaches and what causes them. But it’s still too early to predict the long-term effects of post-COVID headaches or to recommend how best to manage them. According to the National Health Service (NHS), UK, if you experienced headache or migraine prior to COVID infection, and are currently dealing with post-COVID persistent headaches, it is best to stick to your usual headache treatment plan. Many who experience migraine-like post-COVID headache respond well to migraine-specific treatments. Identifying triggers and avoiding them may reduce frequency and severity of headaches. 

Other helpful approaches may be managing stress via meditation, yoga or deep breathing exercises, encouraging a healthy lifestyle by regularly exercising and sleeping well, pursuing a healthy diet, and avoiding large quantities of caffeine or alcohol. For more severe headache episodes, medication and psychotherapy can be considered, although over-the-counter (OTC) drugs are not suitable as a long-term treatment. OTC medication should not be taken for more than one week, as continuous use may lead to medication-overuse headache and worsen the head pain they aim to treat.

Home remedies for migraine — such as cold or hot compresses and aromatherapy — may also give some relief from COVID-19 headache. Also, for each individual affected, keeping track of migraine symptoms can be key to finding the optimum headache solutions. With the causes of post-COVID headache still unknown, an interdisciplinary approach may work well. 

A good defense against post-COVID headache is prevention against catching COVID-19 again. The COVID-19 vaccine can potentially reduce the risk of post-COVID headache and other lingering effects. Besides the vaccine, be sure to mask up and “socially distance,” particularly during surges by COVID-19 variants.  

Want more information? Read our companion blog, COVID and Migraine: What You Need to Know.

Looking for a way to help manage migraine-like head pain after COVID? Take the Mable quiz to see if our DNA-based individualized treatment plan is a good fit for you.

Questions about Mable? Visit our Help Center.

‍