COVID-19 and migraines are both widespread health concerns that have affected millions globally. Research indicates a connection between SARS-CoV-2 infection, the virus causing COVID-19, and the occurrence or worsening of migraine headaches. This relationship highlights how a viral illness can influence neurological conditions.
The Link Between COVID-19 and Migraines
A direct association exists between COVID-19 infection and the development of new-onset migraines or the exacerbation of pre-existing migraine conditions. Studies have shown a wide range in the incidence of headaches during acute COVID-19 infection, from 6.5% to as high as 70.3%. Among those experiencing headaches, some individuals developed new-onset headaches without a prior history, while others with pre-existing headache conditions reported a change in their headache characteristics.
For individuals already living with migraines, COVID-19 infection has been linked to an increase in migraine frequency and severity. One study noted a 59.6% increase in migraine frequency and a 64.1% increase in severity during the pandemic compared to the pre-pandemic period.
How COVID-19 May Trigger Migraines
COVID-19 may trigger or worsen migraines through several biological and physiological mechanisms. One prominent theory involves systemic inflammation, often referred to as a “cytokine storm,” where the body releases high levels of inflammatory molecules called cytokines. These cytokines, such as interleukin-6 (IL-6), can activate pain-sensing neurons in the brain’s protective layers (meninges), leading to headache symptoms that resemble migraines.
The virus can also affect the nervous system directly, leading to neuroinflammation. SARS-CoV-2 binds to ACE2 receptors, which are found on endothelial cells lining blood vessels, including those in the brain. This binding can cause endothelial dysfunction, damaging the inner lining of blood vessels and potentially activating the trigeminal vascular system, a network of nerves and blood vessels involved in migraine pain. This damage can lead to localized inflammation within the brain, contributing to headache development.
The virus may also directly affect nerve endings, particularly those of the trigeminal nerve, which plays a central role in migraine. The virus can also activate inflammatory pathways, sensitizing nerves and contributing to pain. Stress, both physical and psychological, from the illness and pandemic can also trigger migraines.
Understanding Post-COVID Migraines
Migraines can persist or develop as part of “Long COVID,” a condition characterized by lingering symptoms weeks or months after the initial infection. These post-COVID headaches are a common neurological symptom, with prevalence rates varying, but a meta-analysis indicated a frequency of 44%. Some studies suggest headaches are among the top three persistent symptoms.
Post-COVID migraines often share characteristics with typical migraines, such as throbbing pain, often on one side of the head, and sensitivity to light and noise. However, they can also present as a mild, dull headache or, in some cases, a debilitating, daily persistent headache that lasts for an extended period. The underlying mechanisms for these persistent headaches are still being investigated but may involve ongoing immune system activation and neuroinflammation. While many people see their headaches clear up within a few months, some individuals experience symptoms for six months or even longer, making it a significant long-term challenge. The severity of the initial COVID-19 infection does not necessarily predict the risk of developing a Long COVID headache.
Managing COVID-Related Migraines
Managing migraines associated with COVID-19 involves strategies similar to those for other migraine types, with an emphasis on general well-being. Pain relief can be achieved with over-the-counter medications like acetaminophen, ibuprofen, or naproxen for mild to moderate pain. Prescription medications, such as triptans, may be effective for more severe attacks, especially when taken early.
Resting in a quiet, dark environment can help alleviate symptoms, as sensitivity to light and sound is common during a migraine attack. Staying well-hydrated is also beneficial, as dehydration can trigger or worsen headaches. Identifying and avoiding personal triggers, which can vary from person to person, is an important preventive step. Maintaining a regular sleep schedule, engaging in consistent exercise, and practicing stress management techniques like meditation can also contribute to reducing migraine frequency and severity.
It is important to seek medical attention if headaches become more frequent, severe, or do not improve with typical remedies. Immediate emergency care is warranted for new neurological symptoms such as:
- Confusion
- Fainting
- Numbness
- Weakness
- Vision changes
- Stiff neck
- A very high fever alongside a headache
Consulting a healthcare professional is advisable for a proper diagnosis and to develop a tailored treatment plan, especially for persistent or worsening symptoms.