COVID-19, caused by the SARS-CoV-2 virus, presents with a wide range of symptoms, and headaches are frequently reported as a common neurological manifestation. They can be among the first indicators of infection, sometimes appearing before other symptoms. Understanding their nature, causes, and management is important for individuals experiencing COVID-19. This information can help identify potential infection, alleviate discomfort, and guide when to seek medical advice.
Characteristics and Prevalence
COVID-19 headaches present with distinct characteristics. Many describe the pain as moderate to severe, often affecting both sides of the head (bilateral) or feeling like a tightening or pressing sensation. Some report a throbbing or pulsating quality, similar to a migraine, while others experience a dull ache or pressure around the temples or behind the eyes. These headaches can be persistent, rather than intermittent, and may be resistant to typical over-the-counter pain relievers.
Headaches are a common symptom of COVID-19, with prevalence rates varying. Some reports indicate about half of individuals with COVID-19 experience headaches, while others suggest a prevalence of up to 30%. They can appear very early in the infection, often within the first seven days, and sometimes as the initial symptom. While not everyone with COVID-19 develops a headache, it is a frequent neurological sign of the infection.
Underlying Mechanisms
The reasons why COVID-19 causes headaches are still being investigated, but several biological mechanisms contribute. One theory involves systemic inflammation, where the body’s immune response releases pro-inflammatory molecules called cytokines. These cytokines can cause widespread inflammation, including in the brain’s blood vessels and nerves, leading to pressure or throbbing sensations.
Another mechanism involves direct effects of the virus on the nervous system. The SARS-CoV-2 virus may directly affect parts of the trigeminal nerve, which innervates blood vessels in the brain, triggering headaches. Changes in brain blood flow and oxygen shortage (hypoxia) in severe cases are also contributors. While extensive viral infection of brain cells appears uncommon, neurological effects can arise from immune activation and damage to brain blood vessels.
Managing Headaches and When to Seek Medical Attention
Managing acute COVID-19 headaches at home involves strategies similar to those for other headaches. Over-the-counter pain relievers like ibuprofen or acetaminophen can alleviate discomfort. Resting in a quiet, dark room, staying hydrated, and applying cool compresses to the head can also provide relief. Avoiding headache triggers and ensuring adequate rest are beneficial.
Recognize when a headache during COVID-19 warrants medical attention. Seek immediate medical help if the headache is sudden and severe, often described as a “thunderclap” headache. Medical evaluation is necessary if the headache is accompanied by a stiff neck, confusion, weakness on one side of the body, vision changes, or difficulty speaking. A headache that significantly worsens or does not improve with medication indicates a need for professional medical advice.
Headaches in Post-COVID Conditions
Headaches can persist or develop weeks to months after acute COVID-19 infection, forming part of “Long COVID” or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). These post-COVID headaches may differ in characteristics or duration from those experienced during the acute phase. They can occur even in individuals with mild initial infections, highlighting that severe acute illness is not a prerequisite for long-term symptoms.
The cause of these prolonged headaches remains under investigation, but ongoing inflammation, potential nerve damage, and altered brain function are contributing factors. Some experience new or worsened migraines as part of post-COVID conditions. Managing these persistent headaches can be more complex than acute headaches and often requires medical evaluation to determine appropriate treatment strategies.