COVID Headache · What Is It, Symptoms, Treatment, and More

The exact cause of COVID headaches is still unclear, though several mechanisms appear to play a role in its development. Research suggests that COVID headaches may be due to inflammation of the meninges and other pain-sensitive structures in the head or neck, or from damage to small blood vessels in the brain. It is thought that the release of proinflammatory molecules and cytokines could trigger the activation of trigeminal sensory nerve endings during SARS-CoV-2 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 headaches include fever, dehydration, and hypoxemia (i.e., decreased blood oxygen levels). 

Although anyone infected with the virus can develop a COVID headache, it is more common in younger individuals, in those with a prior history of migraines, and in individuals who also experience other neurological symptoms, such as ageusia or anosmia (loss of taste or smell) during infection. Additionally, unvaccinated individuals are at higher risk of developing long-COVID symptoms compared with those who have been vaccinated. 

Treatment of COVID headaches is similar to that of other primary headaches, such as tension headaches or migraines. In most cases, COVID headaches resolve spontaneously within a few days, and individuals are treated with analgesics, like acetaminophen or NSAIDs, to relieve the pain. Additional supportive measures include rest, adequate hydration, limiting caffeine, and maintaining good sleep hygiene. 

It is known that long COVID headache may present either as a worsening of a preexisting primary headache or as a new headache starting during the acute infection or after its resolution. In some individuals, COVID headaches may persist for weeks or months beyond the symptomatic phase. In these cases, it is essential to rule out other causes of the headache and assess its characteristics and frequency.  

Treatment of long-COVID headache may include preventive medications, such as tricyclic antidepressants (e.g., amitriptyline) or anti-seizure medications (e.g., valproate). If these are ineffective, botulinum toxin (i.e., Botox) injections into head and neck muscles can reduce pain by blocking neurotransmitter release from trigeminal sensory nerves. Some evidence also suggests that glucocorticoids may benefit selected individuals with a severe, refractory headache, or evidence of an inflammatory component.