How COVID-19 headaches are 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 controlled her intermittent migraines with medications and Botox injections after a riding accident. But when she contracted COVID-19 in July 2021, the headaches she suffered were “living in hell,” she says.

“Unlike a migraine related to my head injury, this one came down like a blanket being thrown over my head. It wasn’t a process for having a headache. Suddenly I had a headache and it was excruciating. “says Schroeder, a 52-year-old from Knoxville, Tennessee. “A normal migraine for me can be 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, he says. The headache persisted for two weeks and she deprived her of sleep, only allowing her for 15 to 45 minutes at a time. “Many people I know have spent COVID quarantine watching television or reading,” Schroeder says. “I went through it with a cold pack on my head trying to bear the pain of the headache.”

Schroeder is far from alone. In a recent research review, about half of all people with an acute COVID infection developed headaches and it was the first symptom in about a quarter of people. Despite COVID’s classification as a respiratory disease, about one in five patients with moderate to severe COVID report that it was the neurological symptoms, including headache, brain fog, and loss of taste and smell, that bothered them the most.

These percentages are likely an underestimate. “Headache reporting varies depending on whether it is assessed in an inpatient or outpatient setting,” says Mia Tova Minen, head of headache research and neurologist at New York University Langone Health. “It’s probably underestimated by hospitalized patients, in part because there are so many other symptoms that could be at the heart of those patients.”

Types of COVID-19 headaches

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

Schroeder, for example, says her migraines started slowly, giving her time to reduce light exposure and take medication. But her COVID headache came in an instant, and her migraines since her infection haven’t been the same. “My migraines are much less manageable and in the fall and early spring they were much more frequent than ever,” she says.

Her husband, Jesse Trucks, also suffered head trauma from sports injuries and, like his wife, was vaccinated four months before contracting COVID-19. She also developed a headache, which she described as distinct from those resulting from her brain injury. “The pain of COVID headaches was like when the dentist’s drill hits a nerve,” she says. While her headaches typically form a band around the front of her head, her COVID headache instead parked at the base of her neck and in the back of her head, lasting 10 days.

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

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. Numerous studies, however, have identified the most common features of COVID headaches as tension-type headache-like symptoms, occurring on both sides and having a “rubber band-like restriction on the head,” he says. Frontera. 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 “press” or “tighten” quality. Sensitivity to light or sound and nausea or vomiting, on the other hand, occur in less than half of those with COVID headaches.

But some of these tension-type headaches triggered by COVID have another quality that justifies the third category: they last for days, weeks, or even months. These resemble “new persistent daily headaches,” a diagnosis for a headache that simply doesn’t go away and is often triggered by a viral infection, a medical procedure, a stressful life event, or even an airplane trip, he says. Minen. Although formally diagnosed as a new persistent daily headache after 90 days lasting 90 days, Minen says doctors typically recognize these headaches and can start treating them sooner.

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

In a study of over 900 COVID patients, their headaches lasted an average 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 was during acute infection, the longer people were likely to have it.

Causes of COVID-19 headache

Researchers are still learning 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, blood clotting problems. blood or problems with the endothelial cells that form the inner layer of blood vessels. None of these, however, explain all COVID headaches.

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

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

Laura Johansen, a clinical public health researcher in Charlotte, North Carolina, noted that the headache she developed when she suffered from COVID-19 in October 2020 “aligned almost perfectly with the onset of the loss of sense of taste and smell and it worsened together in tandem, ”a common association in research.” Like most cases of COVID headaches, hers was concentrated in the top and front of the head.

“It felt like a sinus headache was meeting a migraine,” says Johansen. “It lasted for about four days, and once installed it was solidly parked – no ebb and flow, just continuous pain.” Even though he took acetaminophen, he said he didn’t do much.

Paracetamol is one of the most common treatments offered by doctors, as are 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 relief from these drugs. Minen says headache specialists will often treat tension-type headaches or persistent daily headaches with gabapentin, a drug also used to treat seizures and nerve pain.

“Of course, if you’re not responding to basic over-the-counter pain medications, it’s probably reasonable to make an appointment with a headache specialist,” says Frontera. “One, to make sure there’s something else going on, and then to define what kind of headache you’re having.” Treatments are different for migraine-like headaches than daily tension-type or persistent headaches, she says.

Long headaches from COVID

Although COVID-related headaches resolve with other symptoms in most people, up to 45 percent of people continue to experience headaches after other symptoms have subsided.

Travis Littlechilds, a systems analyst living in London, has had his COVID headache almost every day for the past four months. His headache during active infection was similar to a migraine, he says, “but extremely sensitive to pressure.” Bending over or coughing was particularly painful. Although his headaches have become less severe, their quality is more or less the same: a strong pressure directly in the back of the head that feels worse with movement.

Others with long COVID have in the same way 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, the headache lasted up to two months for one in six people and up to three months for one in 10 people. For 8% of patients, the headache lasted at least six months. Most COVID headache research 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, headache was among the least symptoms. severe.

Those most likely to develop a long COVID headache are people who have had a history of headaches, who experienced a headache as the first symptom, whose COVID headache lasted the longest. the rest of their COVID symptoms or whose headaches did not respond to painkillers. Those with post-COVID headaches tend to respond well to migraine medications amitriptyline and nortriptyline, Frontera says.

Schroeder, whose illness was mainly her headache and fatigue with no chest tightness or cold, was fortunate enough not to develop a long-lasting 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,” he says. “I look back and wonder how I survived the experience. Strangely, I don’t remember the days at all … but I remember the pain perfectly. “

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