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COVID Headache

What Is It, Symptoms, Treatment, and More

Author: Anna Hernández, MD

Editors: Alyssa Haag, Emily Miao, PharmD, Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy Johnson, LMSW

What is a COVID headache?

COVID headache is one of the symptoms of SARS-CoV-2 infection, the virus responsible for the COVID-19 pandemic. A headache is generally one of the first symptoms to develop during acute infection and often appears simultaneously with other flu-like symptoms, such as fever, fatigue, coughing, and sore throat. Most commonly, COVID headaches and the rest of the symptoms resolve after a few days. However, there are cases where symptoms persist for weeks and even months after the acute infection is gone. Long-COVID or post-COVID syndrome is characterized by various health problems, including cognitive disturbances (e.g., “brain fog”), mood disorders, fatigue, shortness of breath, muscle weakness, and long-term headache.

Although anyone infected with the virus can develop a COVID headache, it is more common in younger individuals; those with a prior history of migraines; and those who also experienced other neurological symptoms, such as loss of taste or smell during infection. Individuals who are unvaccinated against COVID-19 are also at a higher risk of developing long-COVID symptoms when compared to those who are vaccinated against COVID-19.

What causes a COVID headache?

The exact cause of COVID headache is still unclear, though several mechanisms appear to play a role in its development. Research suggests COVID headaches may be due to inflammation of the meninges and other pain-sensitive structures in the head or neck and damage to small blood vessels in the brain. It is thought that releasing proinflammatory molecules and cytokines could trigger the activation of trigeminal sensory nerve endings during the COVID-19 infection, leading to headaches. The coronavirus may also be able to invade these nerves directly, although this has yet to be proven. Additional factors involved in developing COVID headache include fever, dehydration, hypoxia, or decreased oxygen blood levels.

What are the signs and symptoms of a COVID headache?

COVID headache is usually one of the first symptoms to occur during acute COVID-19 infection and may be present during the entire course of the infection. The pain typically starts slowly and affects both sides of the head. It can feel like a tight band squeezing down on the head, applying constant pressure or tension, similar to tension-type headaches. The pain typically starts slowly and affects both sides of the head. Sometimes the headache may worsen with certain factors such as coughing, physical activity, moving the head or neck, and moving the eyes to look in one direction. In other cases, individuals may experience severe, throbbing pain at one side of the head, nausea, vomiting, and sensitivity to light or sound, similar to a migraine headache. 

How is a COVID headache treated?

Treatment of COVID headache is similar to that of other primary headaches, such as tension headaches or migraines. In most cases, COVID headache resolves spontaneously within a few days, and individuals are treated with analgesics, like acetaminophen or NSAIDs, to relieve the pain. Additional measures include resting, drinking plenty of fluids, avoiding caffeine, and maintaining good sleep hygiene.

It is known that a long COVID headache can present in the form of worsening of a preexisting primary headache or, more specifically, in the form of a new headache starting during the acute infection or after the acute infection has resolved. For some individuals, however, COVID headaches may persist for weeks or months beyond the symptomatic phase of infection. In those cases, it is essential to rule out other causes of headache and assess the characteristics and frequency of the headache. Treatment of long-COVID headache can include preventive medications, such as tricyclic antidepressants (e.g., amitriptyline), and anti-seizure medications, like valproate. If these medications are ineffective, botulinum toxin (i.e., Botox) can be injected into the head and neck muscles to block neurotransmitter release from the trigeminal sensory nerve, decreasing the pain sensation. Finally, some data suggest the benefits of glucocorticoids for the treatment of long-COVID headache.

What are the most important facts to know about COVID headaches?

COVID headache is one of the most common neurological symptoms of COVID-19 infection, along with loss of smell or taste. Most cases of COVID headache appear during the acute phase of infection and resolve on their own along with the rest of the symptoms in a few days. In some cases, however, the COVID headache may persist and become chronic, forming part of the long-COVID syndrome or post-COVID-19 syndrome. Treatment of COVID headache includes analgesic medications, resting, and drinking plenty of fluids. Preventive medications or botulinum toxin injections may be used for persistent headaches. 

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