Can COVID Cause Migraines? The Neurological Connection

COVID-19 can trigger migraines and migraine-like headaches, both during acute infection and in the months that follow. Roughly one in five hospitalized patients reports headache as a symptom, and the pain frequently mimics migraine with its throbbing quality, sensitivity to light and sound, and severe intensity. The connection runs deeper than a simple fever headache: SARS-CoV-2 activates specific pain-signaling pathways in the brain that overlap with the biology of migraine, which helps explain why some people develop persistent migraine-like headaches long after the virus clears.

How Common Are Headaches During Acute COVID

Studies consistently place headache among the most frequent neurological symptoms of COVID-19, though the exact numbers vary depending on who was studied and when. In one large study of over 2,100 patients that included both outpatients and those admitted to hospital, about 23% reported headache during their illness, and headache was the single most common first symptom of the infection itself.¹ A separate study of 1,100 hospitalized patients found a slightly lower rate of about 19%, with headache typically appearing within the first two to three days of other COVID symptoms.² In smaller cohorts focused specifically on neurological complaints, rates have been even higher: one study found that nearly two-thirds of patients reported headaches.³

The variation reflects different study designs and populations, but the overall picture is clear: headache is not a rare side note of COVID infection. For many patients it arrives before the cough, fever, or fatigue, making it one of the earliest signals that something is wrong.

What These Headaches Feel and Look Like

COVID-related headaches do not feel like a typical cold headache. They tend to be severe, bilateral, and concentrated in the forehead, with a pressing or pulsating quality. In the large study of over 2,100 patients, pain was bilateral in about 80% of cases, frontal in 71%, and pressing in 75%, with a median duration of seven days.¹ A cross-sectional study of 99 patients found that over 60% rated the pain at seven or higher on a ten-point scale, and nearly 30% experienced photophobia and phonophobia, the hallmark light and sound sensitivity of migraine.⁴

In fact, roughly half of COVID headaches meet formal criteria for a migraine-like phenotype. One study found that 51% of patients had headaches with migraine characteristics, even among people who had never experienced migraine before.³ Physical activity and coughing were the most common aggravating factors, and basic painkillers like paracetamol offered only partial relief in most cases.⁴ Among people with a prior history of migraine, 92% said their COVID headache felt different from their usual attacks.⁴ So COVID does not just reactivate old patterns. It tends to produce a distinct headache that borrows migraine features while feeling unfamiliar to longtime migraine sufferers.

How the Virus Triggers Migraine-Like Pain

The overlap between COVID headaches and migraine is not coincidental. Research points to several biological pathways through which SARS-CoV-2 can activate the same pain-signaling systems involved in migraine.

The most direct evidence involves the trigeminal nerve, the major pain pathway for the head and face. In a mouse model of intranasal SARS-CoV-2 infection, viral proteins were detected inside the trigeminal ganglion, including in neurons that express CGRP and TRPV1, two molecules central to migraine pain.⁵ CGRP (calcitonin gene-related peptide) is the molecule that newer migraine drugs are designed to block, and the virus appears to provoke its release. In human patients, blood levels of CGRP are significantly higher in COVID patients with headache compared to those without, providing strong evidence that the trigeminal system is being switched on by the infection.⁶

Beyond direct nerve involvement, the body’s inflammatory response plays a major role. COVID patients with headache show elevated levels of inflammatory molecules like HMGB1, NLRP3, and IL-6, all of which can activate the trigeminal pain pathway indirectly through the bloodstream.⁷ The inflammatory cascade that COVID is known for, sometimes called a cytokine storm in severe cases, does not stay confined to the lungs. It reaches the brain’s blood vessels, potentially irritating the lining of small vessels and contributing to the throbbing, pulsating quality that makes these headaches feel so migraine-like.⁸

A third pathway involves the small blood vessels themselves. COVID headaches have been linked to elevated markers of endothelial dysfunction, such as C-reactive protein and procalcitonin, which suggests that microvascular injury contributes to the pain.⁹ Damage to the inner lining of blood vessels could help explain why some headaches persist long after the virus is gone: the vascular repair process is slow, and ongoing low-grade inflammation at those sites may keep the trigeminal system irritated.

When COVID Worsens Existing Migraines

People who already live with migraine often find that COVID makes it worse, sometimes dramatically. In one cross-sectional study, patients with pre-existing migraine experienced a significant jump in headache days after infection, from an average of about nine days per month to eleven, along with a significant increase in painkiller use.¹⁰ People with tension-type headache saw their attacks become both more frequent and more severe.¹⁰ A case series similarly reported that most patients with a migraine history saw increased frequency and intensity right after infection, and many described a shift from localized pain to more diffuse, whole-head headaches.¹¹

The biology behind this worsening appears distinct from the new-onset headaches. A prospective cohort study found that patients whose pre-existing headaches worsened after COVID had significantly higher blood levels of VEGF (a growth factor tied to blood vessel changes) and TGF-β1 compared to patients whose headaches stayed the same.¹² Elevated CX3CL1, a signaling molecule associated with microglial activation in the brain, was also more prominent in those with worsened headaches. These biomarker differences hint that in people with an existing migraine brain, COVID may push already-sensitized pathways into overdrive through both peripheral inflammation and direct brain immune-cell activation.

A study of over 200 patients with COVID-related headaches found that those who had headaches before the infection experienced a different pain profile afterward: more intense, fiery-type pain that spread across the whole head and responded less well to paracetamol than headaches in people who were new to the problem.¹³

New Headaches That Outlast the Infection

For some people, the headache that starts with COVID never really goes away. In the large study of over 2,100 patients, 13% still had headache a month after onset.¹ A population-based follow-up study tracked patients who had no history of headache before COVID and found that about 16% developed new persistent headaches. Nearly two-thirds of those headaches fulfilled criteria for migraine-like headache.¹⁴

These persistent post-COVID headaches often resemble a condition called new daily persistent headache, a type of chronic daily headache that switches on abruptly following an identifiable trigger and then stubbornly refuses to resolve. Reviews of the literature describe them as moderate to severe, persistent, and frustratingly resistant to standard treatment.¹⁵

Certain risk factors predict who is more likely to get stuck with chronic daily headache after COVID. A prospective study found that people who had any headache history before infection and those whose headache was more intense during the acute phase were at higher risk. The chronic group also skewed more female and was more likely to still be experiencing headache beyond four months.¹⁶ Having headache at the very onset of COVID appears to be a warning sign: a study of 1,100 hospitalized patients found that headache at onset was independently associated with long-term post-COVID headache and fatigue at follow-up.²

What Brain Imaging Shows

Brain scans of people with persistent post-COVID headache reveal measurable structural and functional changes. In one MRI study, white matter lesions were found in half of post-COVID headache patients compared to 20% of controls.¹⁷ Another study using detailed MRI on 40 patients with persistent headache who had no prior headache history found reduced gray matter volume and cortical thickness in the inferior frontal and fusiform cortex, along with white matter changes concentrated in the corpus callosum and left hemisphere.¹⁸

The functional side is equally telling. A study using functional MRI found that people with ongoing post-COVID headache showed disrupted brain dynamics in temporal, sensorimotor, and insular regions, areas involved in pain processing and body awareness. People whose headache had already resolved showed elevated activity in the same regions, as if the brain were compensating on its way back to normal.¹⁹ These imaging findings reinforce the idea that post-COVID headache is not “just a headache” but involves real changes to the brain’s structure and the way it processes sensory information.

Which Variants Cause More Headaches

Not all waves of the pandemic produced equal headache rates. A cross-sectional study of unvaccinated hospitalized patients compared headache prevalence across the Wuhan, Alpha, and Delta variants. The Delta variant stood out: about a third of patients infected with Delta had headache at admission, compared to roughly 21% for Wuhan and 12% for Alpha. The gap persisted into long COVID, with headache at six months reported by about 13% of Delta patients versus 6% for Wuhan and 4% for Alpha.²⁰ The researchers could not determine exactly why Delta caused more headaches, but the pattern underscores that the clinical picture of COVID shifts with each variant.²¹

This is worth knowing for practical reasons. If you had a mild COVID infection during an Omicron-dominant wave without much headache, a future infection with a different variant could produce a very different neurological experience. Variant-level differences also complicate research: a study conducted during one wave may not fully apply to the next.

Treatment When COVID Headaches Persist

Standard over-the-counter painkillers often fall short for post-COVID headaches, as studies consistently note partial or poor responses to first-step analgesics. This treatment resistance is one of the most frustrating aspects of the condition. But because COVID headaches share biology with migraine, particularly the CGRP pathway, migraine-specific treatments have shown promise.

In a case series of nine patients with persistent headache after COVID, treatment with CGRP monoclonal antibodies, the same class of drugs now widely used for chronic migraine prevention, produced striking results. Median monthly headache days dropped from 25 to 5, headache severity scores fell from 8 to 3, and medication use decreased significantly.²² The patients also reported significant improvement in headache-related disability and depressive symptoms. While this is a small case series rather than a large trial, the response fits neatly with the biological evidence that CGRP is elevated in COVID headache patients, making these drugs a logical therapeutic target.

If you are dealing with persistent post-COVID headache, the practical takeaway is that a conversation with a headache specialist or neurologist may be more productive than cycling through ever-higher doses of ibuprofen. The overlap with migraine biology means that migraine treatment frameworks, including preventive medications, are worth exploring.

COVID Vaccination and Migraine Flare-Ups

People with migraine have also reported flare-ups after COVID vaccination, which raises a separate but related question. In rare cases, vaccination has been linked to severe prolonged migraine episodes, potentially driven by the inflammatory response the vaccine is designed to trigger.²³

However, the picture is more nuanced than it first appears. A study of 550 migraine patients found that roughly equal proportions reported worsening after infection and after vaccination. But when researchers checked electronic headache diaries, they found no objective increase in headache frequency in the month after infection or vaccination, even among patients who said their migraines had gotten worse. The strongest predictor of perceived worsening was worrying about worsening itself, particularly after vaccination, where concern about migraine flare-ups carried a very high odds of self-reported worsening.²⁴ This does not mean every report of post-vaccination migraine worsening is imagined, but it does suggest that a nocebo effect, where expecting a negative outcome makes you more likely to experience or notice it, plays a meaningful role. The inflammatory immune response from vaccination can trigger headache in anyone, and in someone primed to worry about migraine, that headache may be experienced as a migraine flare even when diary-tracked frequency has not actually changed.

The POTS Connection

Some people who develop post-COVID headaches are actually dealing with a broader problem involving the autonomic nervous system. Post-COVID postural orthostatic tachycardia syndrome (POTS) is a condition where the heart rate spikes abnormally when standing up, causing dizziness, fatigue, brain fog, and headache. In a study of 16 patients diagnosed with post-COVID POTS, chronic migraine was the most common coexisting condition, present in more than a third of the group.²⁵

This overlap matters because treating the headache alone may not be enough if the underlying dysautonomia is not addressed. If your post-COVID headache gets worse when you stand up, improves when you lie down, or is accompanied by a racing pulse, lightheadedness, or exercise intolerance, POTS may be part of the picture. The treatment approach for POTS, which includes increased fluid and salt intake, compression garments, and sometimes medications to manage heart rate, can improve headache indirectly by stabilizing the cardiovascular dysfunction feeding into it.

Children and Teenagers

Adults are not the only ones affected. Persistent headache after COVID has been documented in pediatric patients as well. Case reports from a tertiary headache center describe children and adolescents who developed probable new daily persistent headache after COVID-19 infection.²⁶ While the evidence base is still limited to case reports rather than large studies, these cases highlight that the neurological consequences of COVID extend to younger populations. Pediatric headache specialists have flagged the importance of considering recent COVID infection as a potential trigger when a child presents with sudden-onset chronic headache that does not fit their usual pattern. Early recognition matters because the treatment approach for new daily persistent headache differs from typical childhood migraine management, and delays in diagnosis can lead to months of unnecessary suffering and school absence.

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