COVID-19 presents with various symptoms affecting different bodily systems. While respiratory issues are commonly recognized, headaches are also a frequent symptom of the infection. Understanding their characteristics and causes can help individuals manage the illness.
Prevalence and Typical Presentation
Headaches are a common symptom among individuals with COVID-19, affecting a significant percentage of patients (10% to nearly half). They are more frequent in younger patients and those with a history of primary headaches or migraines. Headaches often emerge early in the illness, sometimes as the first or only symptom.
COVID-19 headaches are described as moderate to severe. The pain is often felt bilaterally or frontally, like pressure, throbbing, or a dull ache, sometimes resembling a tight band around the head. These headaches can resemble tension-type headaches or migraines, potentially accompanied by sensitivity to light and sound, nausea, or visual disturbances. Physical activity, coughing, or head movement may intensify the pain. Headaches during the acute phase can also occur alongside other symptoms such as loss of smell or taste and muscle aches.
Understanding the Underlying Mechanisms
Headaches during COVID-19 infection are linked to the body’s response to the virus. A primary factor is systemic inflammation, where the immune system releases cytokines. Pro-inflammatory cytokines, like interleukin-6 (IL-6), affect blood vessels and nerves, including those in the brain, causing pressure or throbbing.
COVID-19 can also affect the nervous system. The virus may activate the trigeminal nerve, a cranial nerve involved in headaches. Hypoxemia (low blood oxygen), which can occur with respiratory complications, may also contribute. Fever and dehydration, common during viral infections, can also worsen headache intensity.
Persistent Headaches After Acute Infection
For some individuals, headaches can persist or develop after the acute phase of COVID-19 resolves, associated with “long COVID” (Post-Acute Sequelae of SARS-CoV-2 infection or PASC). These persistent headaches can last for weeks or months, even in those with mild initial infections. They may present as chronic daily headaches or new-onset migraines. Those with a pre-existing headache history might experience worsening patterns, with increased frequency and severity.
The mechanisms behind these lingering headaches are still being investigated, but ongoing inflammation is a factor. Even after the virus is cleared, persistently elevated cytokines, such as IL-6, suggest continued inflammation. Neurological changes, including altered gray matter volume and immune system dysregulation, are also hypothesized to contribute to these post-COVID headaches.
When to Seek Medical Advice and Management
When experiencing headaches, especially with COVID-19, it is important to know when to seek medical attention. Seek immediate medical consultation if a headache appears suddenly and is unusually severe, often described as a “thunderclap” headache. Seek prompt evaluation if a headache is accompanied by a stiff neck, confusion, difficulty speaking, weakness, vision changes, or loss of consciousness, as these may indicate a serious underlying condition. If a headache worsens significantly despite attempts at management, consulting a healthcare provider is advised.
For general management of COVID-related headaches, several strategies can provide relief. Ensuring adequate rest and staying well-hydrated are beneficial. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate mild to moderate pain, and applying cold or warm compresses may offer comfort. Limiting screen time can reduce eye strain and potentially ease headache symptoms. For persistent or severe headaches, or if there is concern about the headache’s nature, consulting a healthcare provider for personalized advice and diagnosis is recommended.