Is there a connection between Long COVID and headaches?

Nov 19, 2021

Although symptoms of COVID-19 and Long COVID vary, headaches are common for both patient groups.

COVID-19-related headaches have been described as being moderate to severe in intensity, with some patients experiencing either pulsing or pressing pain on both sides of the head and migraine-like features. COVID-19 headaches are not only experienced by those prone to headaches historically. In one study of healthcare professionals with COVID-19 headaches, over 70% reported no prior-history of headaches. While a history of headaches is not always present, COVID-19 may increase the frequency or the severity of headaches for those that suffer them regularly.

While estimates vary considerably across studies, between 14-60% of patients with acute (non-long term) COVID-19 reported headaches as a symptom. As a longer-term symptom, approximately 5% of patients report experiencing headaches 12 or more weeks after their initial COVID-19 diagnosis. However, there is variability across studies, with one study finding that 55% of cases reported headaches 6 or more weeks after their COVID-19 diagnosis.

What is the difference between migraines and COVID-19 headaches? Generally, migraines are considered “primary headaches,” while COVID-19 headaches are “secondary headaches” due to the underlying relationship to COVID-19 (even though they may be migraine-like). People with a history of migraines have also reported differences between COVID-19 headaches and migraines. For example, COVID-19 headaches may not involve other migraine symptoms (e.g., nausea, vomiting, or sensitivity to light and sound), may be felt on both sides of the head rather than one, may not respond to migraine medications, and may not be preceded by the typical migraine aura.

Causes of Long COVID headaches

It is still unclear as to why Long COVID develops – and why it occurs in some people with COVID-19 but not others. Researchers are studying a variety of hypotheses, including the potential impact of immune activation from the initial infection and the potential role of initial damage to organs from the virus. Studying other post-viral syndromes may help shed some light on the causes and implications of Long COVID.

As with Long COVID overall, the causes of Long COVID-related headaches are uncertain. Some of the leading theories range from the virus directly invading nerve cells and causing damage, indirect effects of low oxygen levels in tissues, high blood pressure, an inflammatory “cytokine storm” on the central nervous system, and/or the worsening of pre-existing or new brain diseases.

How to treat and prevent Long COVID headaches

Management approaches for Long COVID headaches are still being evaluated. Currently, Long COVID headaches are often managed with medications, rehabilitation, and/or psychological support. Additional research is needed to define which management approaches are most useful for Long COVID headaches.

While it may seem intuitive, preventing COVID-19 is the best way to prevent Long COVID, including Long COVID headaches. The best prevention tools are:

  1. Getting vaccinated. In addition to lowering the risk of COVID-19 infection, emerging evidence from the United Kingdom suggests that vaccination may reduce the risk of Long COVID for those infected after they receive the shot.
  2. Wearing a mask. Masking as recommended by public health authorities is critical to further minimize your own risk of infection and to help protect those not yet eligible for vaccination, with weakened immune systems, or with underlying conditions.
  3. Getting tested. Test weekly if you are unvaccinated. If you are vaccinated but develop symptoms of COVID-19, come into contact with someone known to have COVID-19, or participate in an activity where risk of infection is higher, get tested.

Populations at greater risk of Long COVID

Generally, Long COVID can impact anyone who was infected with COVID-19, although studies suggest that some people may be at a higher risk for Long COVID. For example, patients with severe COVID-19 symptoms during the initial infection seem to be more likely to develop Long COVID, as do those with certain chronic health conditions. In one study, headache was among multiple COVID-19 symptoms that were associated with development of Long COVID. Female sex may also be associated with higher risk of Long COVID and females may be more likely to have headaches as a symptom of Long COVID. Preliminary evidence suggests that children also experience symptoms of Long COVID, including headaches, even among those that had asymptomatic disease. However, additional research is needed to define risk factors for Long COVID, generally, and Long COVID headaches, specifically.

It is essential to note that given the disproportionate impact of COVID-19 on communities of color, Long COVID, too, may be affecting communities of color more than whites. It is critical that we understand the health equity implications of Long COVID, work with communities to determine how to best support people with Long COVID, and ensure access to high-quality and affordable care for the condition. Additional research is needed to understand the burden of Long COVID by race/ethnicity and other sociodemographic characteristics.

The Long COVID initiative

The Long COVID initiative at the Brown University School of Public Health brings together researchers, clinicians, and experts in policy as well as strategic communications, to rapidly study and report on the significant impact of Long COVID on people, communities, workplaces, healthcare, and society as a whole. The team strives to answer pressing questions including: what is the impact of Long COVID on quality of life, social well-being, independence, and household and labor force productivity? How can employers, policies, and programs best support people with Long COVID? How can the healthcare system and social programs best support people with Long COVID and prepare for the costs associated with Long COVID?

The initiative is led by Dean Ashish Jha and Associate Dean Megan Ranney of the Brown School of Public Health, with funding for the first year provided by the Hassenfeld Foundation. Under the leadership of Drs. Jha and Ranney, Dr. Orestis Panagiatou and Laura Chambers are co-directing initiative activities, with expert advisors Stefanie Friedhoff and Dr. Phil Chan and very broad-based collaboration across Brown, its affiliated hospitals, and the Rhode Island Department of Health, among others.

For inquiries related to the Long COVID Initiative, please contact long_covid_initiative@brown.edu