How are COVID-19 headaches different from others and how to manage them

As a survivor of a traumatic brain injury that occurred just over a decade ago, Heather Schroeder is no stranger to headaches. She has controlled her intermittent migraines with medication and Botox injections ever since she had a horseback riding accident. But when she contracted COVID-19 in July 2021, the headaches she suffered from were “hell,” she says.

“Unlike a migraine related to my TBI, this one fell like a blanket over my head. It was not a process of getting a headache. All of a sudden I had a headache and it was excruciating,” says Schroeder, a 52-year-old man from Knoxville, Tennessee. “A normal migraine for me can be an eight or nine out of 10, with vomiting, sensitivity to light and post-migraine discomfort. This headache was a 20 out of 10.”

Neither Tylenol nor migraine rescue medications reduced the pain, she says. The headache persisted for two weeks and deprived her of sleep, allowing her only 15 to 45 minutes at a time. “A lot of people I know spent their COVID quarantine watching TV or reading,” says Schroeder. “I spent a lot of time with a cold compress on my head trying to endure the pain of the headache.”

Schroeder is far from alone. In a recent review of research, about half of all people with an acute COVID infection developed a headache, and it was the first symptom in about a quarter of people. Despite the classification of COVID as a respiratory illness, approximately one in five patients with moderate to severe COVID report that it was neurological symptoms, including headache, mental confusion, and loss of taste and smell, that they were most affected by. they bothered

Those percentages are probably an underestimate. “Reporting of headaches varies depending on whether you are evaluated as an inpatient or an outpatient,” says Mia Tova Minen, chief of headache research and a neurologist at New York University Langone Health. “Hospitalized patients are likely underreporting in part because there are so many other symptoms that might be the focus of attention for those patients.”

Types of COVID-19 headaches

A headache is usually an early symptom of COVID and typically bilateral, occurring on both sides of the head, or “the whole head,” as some have described it. The pain varies from moderate to severe, but several people said National Geographic that the pain was much worse than with previous headaches; others rated the pain on par with previous migraines. But between 47 percent and 80 percent of people with a history of headaches described their COVID headache as different from their previous ones, with sudden, severe pain.

Schroeder, for example, says his migraines used to start slowly, giving him time to reduce light exposure and take medication. But his COVID headache appeared in an instant, and his migraines since he got infected are not the same. “My migraines are much less controllable, and in the fall and early spring they were much more frequent than ever before,” she says.

Her husband, Jesse Trucks, also suffered a traumatic brain injury from sports injuries and, like his wife, had been vaccinated four months prior to contracting COVID-19. He also developed a headache, which he described as distinct from those resulting from his brain injury. “The COVID headache was like when the dentist’s drill hits a nerve,” she says. While her headaches generally formed a band around the front of her head, her COVID headache was stationary at the base of her neck and the back of her head, and lasted 10 days.

Headaches reported by people with acute COVID fall into three main categories, according to Jennifer Frontera, a neurologist at New York University Grossman School of Medicine: migraine-type, tension-type and daily persistent headaches. Each of these corresponds to types of headache diagnoses that already exist.

Some people with COVID describe a migraine-like headache, with throbbing on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light and sound. However, several studies have identified the most common features of COVID headaches as symptoms similar to those of tension-type headaches, occurring on both sides and having a “rubber band-like restriction on the head.” Border says. Between 70 and 80 percent of people say they occur on both sides and the front of the head and describe them as having a “pressing” or “squeezing” quality. Sensitivity to light or sound and nausea or vomiting, on the other hand, occur in less than half of people with a COVID headache.

But some of these COVID-triggered tension-type headaches have another quality that justifies the third category: They last for days, weeks, or even months. These resemble “new daily persistent headaches,” a diagnosis of a headache that just won’t go away and is often triggered by a viral infection, medical procedure, stressful life event, or even car travel. plane, says Minen. Although it’s only formally diagnosed as a new persistent daily headache after 90 days, Minen says doctors usually recognize these headaches and can start treating them sooner.

New daily persistent headaches may be less responsive to standard migraine headache treatments or traditional tension-type headaches, leading many headache specialists to link them to ongoing headaches that people describe during a COVID attack, says Minen.

In a study of more than 900 COVID patients, their headache lasted a median of 14 days, but one in five patients still had it three months later; one in six patients had it nine months later. The worse the headache during acute infection, the more likely people were to have it.

Causes of COVID-19 headache

Researchers are still learning about the specific mechanisms of a COVID-19 headache, but some possibilities include direct injury from the virus, a response to inflammation as the body fights infection, less oxygen in the blood, dehydration, problems with blood clotting or problems with the endothelial cells that make up the inner lining of blood vessels. However, none of these explains all the headaches of COVID.

“There are probably slightly different mechanisms at play,” says Frontera. “The most compelling pathologic data pertains to microvascular injury,” she says. The negative effects of COVID-19 on blood vessels are well known and can affect the trigeminal nerve, the largest cranial nerve responsible for facial sensations and motor activities such as chewing and swallowing. Located near the temple, in front of the ears on each side of the head, each trigeminal ganglion, a group of nerves, has three branches along the upper, middle, and lower parts of the face.

“There is an association between headache and loss of the sense of smell and taste, so one potential mechanism could be that there is some kind of damage to that olfactory pathway,” says Minen. “It could be that the COVID is entering through the nose and there is inflammation in the nasal cavity. That then activates branches of the trigeminal nerve, which can cause headaches.”

Laura Johansen, a public health clinical researcher in Charlotte, North Carolina, noted that the headache she developed when she had COVID-19 in October 2020 “aligned almost perfectly with beginning to lose her sense of taste and smell, and it got worse at the same time. ”, a common association in research. Like most COVID headaches, hers was concentrated in the top and front of her head.

“It felt like a sinus headache meets a migraine,” says Johansen. “It lasted about four days, and once it set in, it was solidly parked, no ebbs and flows, just continual pain.” Although he took acetaminophen, he said it didn’t do much.

Paracetamol is one of the most common treatments offered by doctors, as well as non-steroidal anti-inflammatory drugs, metamizole, triptans, or a combination of these, but only a quarter of people report complete relief; only half reported getting any relief from these medications. Minen says headache specialists often treat tension-type headaches or persistent daily headaches with gabapentin, a medication also used to treat seizures and nerve pain.

“Certainly, if you’re not responding to basic over-the-counter pain relievers, it’s probably reasonable to make an appointment with a headache specialist,” says Frontera. “One, to make sure nothing else is going on, and then to define what kind of headache you have.” Treatments are different for migraine-type headaches versus persistent daily or tension-type headaches, she says.

Long COVID headaches

Although COVID-related headaches go away with other symptoms in most people, up to 45 percent of people continue to have a headache after other symptoms go away.

Travis Littlechilds, a systems analyst based in London, has had a COVID headache most days for the past four months. His headache during active infection was similar to a migraine, he says, “but more sensitive to pressure.” Bending over or coughing was particularly painful. Although her headaches have become less intense, their quality is more or less the same: heavy pressure directly on the back of her head that is made worse by movement.

Others with prolonged COVID have Similary reported that the headache they developed during the infection never went away. In a meta-analysis of 36 studies involving more than 28,000 people, headache lasted up to two months in one in six people and up to three months in one in 10. For 8% of patients, headache headache lasted at least six months. Most research on COVID headaches doesn’t address whether symptoms differ for vaccinated or unvaccinated people, but at least one recent study found that for those who were vaccinated or boosted, headaches were among the less severe symptoms.

People most likely to develop a prolonged COVID headache are people who had a history of headaches, who experienced a headache as their first symptom, whose COVID headache lasted longer than the rest of their COVID symptoms, COVID or whose headache did not respond to pain relievers. People with post-COVID headaches tend to respond well to the migraine medications amitriptyline and nortriptyline, Frontera says.

Schroeder, whose illness was primarily headache and fatigue with no chest tightness or cold, was fortunate not to develop a prolonged COVID headache, and she and her husband continue to take precautions to avoid another infection.

“I never want to have a headache like that again,” she says. “I look back and wonder how I survived the experience. Oddly enough, I don’t remember the days well at all… but I can perfectly remember the pain.”

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