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 has controlled her intermittent migraines with medication and Botox injections since a riding accident. But when she caught COVID-19 in July 2021, the headaches she suffered were “living hell,” she says.

“Unlike a migraine related to my TBI, this one came down like a blanket thrown over my head. It wasn’t a process of having a headache. I suddenly had a headache, and it It was excruciating,” says Schroeder, 52, of Knoxville, Tennessee. “A normal migraine for me can be eight or nine out of 10, with vomiting, sensitivity to light and post-migraine discomfort. was a 20 out of 10.

Neither Tylenol nor migraine reliever medication reduced the pain, she said. The headache persisted for two weeks and deprived her of sleep, giving her only 15 to 45 minutes at a time. “A lot of people I know spent their COVID quarantine watching TV or reading,” Schroeder says. “I spent it with a cold compress 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 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 disease, about one in five patients with moderate to severe COVID report that it is neurological symptoms – including headaches, brain fog and loss of taste and smell – that cause them. disturb the most.

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

Types of headaches linked to COVID-19

A headache is usually an early symptom of COVID and usually bilateral – 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 much worse than with the previous headaches; others rated the pain as comparable to past migraines. But between 47 and 80 percent of people with a history of headaches described their COVID headache as different from previous ones, with both sudden and intense pain.

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

Her husband, Jesse Trucks, also suffered TBI from sports injuries and, like his wife, had been vaccinated four months before contracting COVID-19. He also developed a headache, which he described as distinct from those resulting from his brain injury. “The pain from the COVID headache was like when the dentist’s drill hits a nerve,” he says. While her headaches usually form a band around the front of her head, her COVID headache instead parked at the base of her neck and 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-like, tension-like, and persistent headaches. dailies. Each of them 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. Several studies, however, have identified the most common features of COVID headaches as symptoms similar to tension-type headaches, which occur on both sides and have more of a “rubber band-like restriction on the head.” Frontera says. Between 70 and 80% of people report that they occur on both sides and the front of the head and describe them as having a “squeezing” or “tightening” quality. Sensitivity to light or sound and nausea or vomiting, on the other hand, occur in less than half of people 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, even months. These look like “daily new persistent headaches”, a headache diagnosis that just doesn’t go away and is often triggered by a viral infection, medical procedure, stressful life event or even a plane trip, says Minen. Although only formally diagnosed as a new daily persistent headache after lasting 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 headache treatments for migraine or traditional tension-type headaches, leading many headache specialists to link them to ongoing headaches that people describe during an episode of COVID, Minen says.

In a study of more than 900 COVID patients, their headache 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 more severe the headache was during an acute infection, the longer people were likely 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 by the virus, an inflammatory response as the body fights infection, less oxygen in the blood, dehydration, blood clotting problems or problems with endothelial cells that form the inner layer of blood vessels. However, none of these explains all the headaches related to COVID.

“There are probably slightly different mechanics at play,” Frontera says. “The most compelling pathological data is for microvascular lesions,” she says. The negative effects of COVID-19 on blood vessels are well known and can affect the trigeminal nerve, the largest cranial nerve and the one 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 upper, middle and lower parts of the face.

“There’s an association between headaches and loss of smell and taste, so one potential mechanism could be that there’s some kind of damage to that olfactory pathway,” Minen says. “It may be that COVID enters 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 researcher in public health in Charlotte, North Carolina, noticed that the headache she developed when she suffered from COVID-19 in October 2020 “aligned almost perfectly with the onset of loss of my sense of taste and smell, and worsened together in tandem,” a common association in research. Like most COVID headaches, his was concentrated at the top and front from his head.

“It was like a sinus headache meeting a migraine,” says Johansen. “It lasted about four days, and once it settled in it was solidly parked – no ebb and flow, just continuous pain.” Although she took acetaminophen, she said it didn’t do much.

Acetaminophen is one of the most common treatments offered by doctors, along with nonsteroidal anti-inflammatory drugs, metamizole, triptans, or a combination of these, but only a quarter of people report complete relief; only half said they got relief from these drugs. Minen says headache specialists often treat tension headaches or persistent daily headaches with gabapentin, a drug also used to treat seizures and nerve pain.

“Granted, if you don’t respond to basic over-the-counter pain relievers, it’s probably reasonable to make an appointment with a headache specialist,” Frontera says. “First, to make sure nothing else is going on, then to work out what type of headache you have.” Treatments are different for migraine-type headaches compared to daily tension-type or persistent headaches, she says.

Long COVID headaches

Although COVID-related headaches disappear with other symptoms in most people, up to 45% of people continue to experience headaches after other symptoms disappear.

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

Others with long COVID have Likewise 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 research on COVID headaches doesn’t specify 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 part of the symptoms. the least serious.

The people most likely to develop a long 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 or whose headache has not responded to pain medication. People with post-COVID headaches tend to respond well to migraine medications amitriptyline and nortriptyline, Frontera says.

Schroeder, whose illness was primarily her headache and fatigue without any chest tightness or sniffling, was lucky not to develop a long 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 that experience. Oddly, I don’t remember the days at all…but I remember the pain perfectly.

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