COVID Headache: What It Feels Like and What to Do

A COVID headache typically hits as intense, bilateral (both-sides) pain that shows up within the first two or three days of infection, often alongside fever and cough. Roughly one in five hospitalized COVID patients reported headache during the acute phase in one large study, and the character of the pain has some features that set it apart from a garden-variety tension headache. The picture gets more complicated when headaches linger for weeks or months after the virus clears, which happens more often than most people expect.

What a COVID Headache Actually Feels Like

Among more than 1,100 patients hospitalized with SARS-CoV-2, about 19% reported headache during the acute illness. Most described it as very intense pain affecting both sides of the head, typically appearing within 48 to 72 hours of their first COVID symptom.¹ People often describe a pressing or squeezing quality, though some report pulsating or throbbing pain. It tends to be moderate to severe, and in many cases it does not respond well to the usual over-the-counter painkillers that knock out a normal headache.

The pain can show up alone, but it rarely does. Fever was present in about 89% of hospitalized COVID patients with headache, cough in about 86%, and abnormal blood markers of inflammation in the vast majority.² Headache during COVID does not live in isolation: it comes wrapped in a package of systemic illness. That context matters for figuring out whether your headache is just a headache or part of something that needs more attention.

Why COVID Causes Head Pain

The virus does not simply give you a headache the way dehydration or eyestrain does. Several mechanisms appear to work together, and researchers are still sorting out exactly how much each one contributes.

The leading explanation involves the body’s inflammatory response. When SARS-CoV-2 infects you, the immune system releases a surge of signaling molecules called cytokines. In some people this response becomes excessive, and the resulting inflammation can irritate pain-sensing nerve pathways, including the trigeminal system, which is the main nerve network responsible for sensation in the face and head.³ This same trigeminal activation may help explain why headache and loss of smell so often overlap during COVID: the nerve pathways involved in both functions sit close together and can be irritated by the same inflammatory cascade.

Beyond the trigeminal pathway, the broader inflammatory storm drives other headache-generating problems. Elevated levels of cytokines like TNF-α, IL-18, and VEGF have been measured in COVID patients with neurological symptoms, suggesting both widespread immune activation and potential disruption of the blood-brain barrier.⁴ When that barrier becomes leaky, inflammatory molecules that normally stay in the bloodstream can reach brain tissue, contributing to headache and other neurological symptoms. Researchers have also categorized COVID headaches into several subtypes depending on the underlying driver: headaches from the systemic viral infection itself, headaches from low oxygen levels, headaches linked to increased pressure in the cerebrospinal fluid, and even cough headache triggered by the violent coughing fits COVID can produce.⁵

When to Be Concerned

Most COVID headaches, while unpleasant, resolve as the infection clears. But COVID headache comes bundled with an unusually high number of clinical “red flags,” which is a term doctors use for symptoms that signal something potentially more serious could be going on. In a series of 104 hospitalized patients with COVID and headache, virtually all had at least one red flag related to the headache itself, and about 83% also had some kind of neurological symptom beyond the headache.²

That does not mean every COVID headache is dangerous. It means COVID headaches almost always happen alongside systemic illness, and doctors take them seriously because the same virus can, in rare cases, cause meningitis, encephalitis, or stroke. Symptoms worth acting on quickly include:

Sudden thunderclap pain: headache that reaches maximum intensity within seconds, which can signal bleeding or a vascular event.
Stiff neck with high fever: a classic sign of meningeal irritation that warrants immediate evaluation.
Confusion or personality changes: trouble forming sentences, uncharacteristic behavior, or inability to stay alert suggests the brain itself may be affected.
Weakness on one side: facial drooping, arm weakness, or difficulty walking could indicate stroke, which COVID does occasionally cause.
Seizures: any new seizure during COVID infection should be treated as a medical emergency.

The vast majority of people with a COVID headache will not experience these complications, but the threshold for seeking care should be lower than with an ordinary headache, especially early in the illness when the inflammatory response is peaking.

What You Can Take for It

Early in the pandemic, a wave of social media warnings claimed that ibuprofen and other anti-inflammatory painkillers could worsen COVID. That fear turned out to be unfounded. Multiple studies have found that NSAIDs like ibuprofen and naproxen neither increase the risk of catching SARS-CoV-2 nor worsen outcomes in people who already have COVID. Public health agencies worldwide now support using these drugs for fever and pain relief during the illness.⁶

Acetaminophen (paracetamol) also remains a reasonable first-line option, particularly if you have stomach issues or other reasons to avoid NSAIDs. In practice, many people find that a COVID headache responds only partially to standard painkillers, especially if the headache is driven more by inflammation and trigeminal irritation than by simple muscle tension. Staying well hydrated, resting in a dark and quiet room, and applying a cool compress to the forehead are all straightforward steps that can take the edge off. None of these are revolutionary advice, but they are worth mentioning because many people push through a COVID headache the way they would a mild tension headache, only to find the pain ramps up when they are overtired or dehydrated.

One important caveat: if you find yourself reaching for painkillers daily for more than a week or two, talk to a doctor. Frequent use of acute headache medication can lead to medication-overuse headache, which creates a frustrating cycle where the very drugs you are taking to relieve the pain start contributing to it.

The Headache That Does Not Go Away

For some people, the headache outlasts the infection by weeks or months. A prospective study found that headache persisted beyond the acute phase of COVID in about half of patients who had it during their illness, and roughly one in five went on to develop chronic daily headache, defined as headache on 15 or more days per month.⁷ People whose headaches were more severe during the acute phase and those with a prior headache history were at higher risk of this progression. Women were also overrepresented in the chronic daily headache group.

Some of these persistent headaches fit the profile of a condition called new daily persistent headache (NDPH), where a headache begins on a specific day and simply never stops. NDPH is a recognized headache disorder that has long been associated with viral infections, and COVID appears to be a potent trigger. Case reports and systematic reviews describe patients developing daily headache starting with their COVID infection and continuing for months afterward, meeting the formal diagnostic criteria for NDPH.⁸ Recognizing the NDPH pattern matters because it changes the treatment approach: NDPH is notoriously stubborn and does not always respond to the standard migraine or tension-headache playbook.

Having headache at the start of a COVID infection also seems to predict other long-COVID symptoms. In one study, people who had headache during acute COVID were more likely to report persistent headache and fatigue months later compared to those who did not have headache initially.¹ The headache appears to be a marker, not just of pain sensitivity, but of a more robust neuroinflammatory response to the virus.

If You Already Get Migraines

People with a pre-existing migraine condition often report that COVID makes things worse, sometimes dramatically. A case series found that most migraine patients experienced increased frequency and intensity of their headaches shortly after COVID infection, and many described a shift from their usual localized pain to a more diffuse, whole-head headache that felt different from their typical attacks.⁹ Some also developed new symptoms like brain fog and, in unusual cases, difficulty finding words.

Perhaps the most frustrating finding from that series was that previously effective migraine medications stopped working as well after COVID. Six of the patients needed to change their treatment regimen, and standard options like Botox and CGRP-targeting therapies had mixed results. The mechanism behind this worsening is not fully understood, but the inflammatory disruption that COVID causes in the trigeminal system and blood-brain barrier likely lowers the threshold for triggering migraines and may alter how well existing preventive medications function.

Interestingly, one Chinese study observed an opposite trend during the pandemic period itself: patients with pre-existing headache disorders who were surveyed during COVID lockdowns actually reported a modest reduction in headache days, duration, and intensity, which the researchers attributed in part to reduced work stress and increased family support.¹⁰ The distinction here is between the pandemic as a lifestyle event versus the virus as a biological insult. The lockdown environment may have helped some headache sufferers by removing triggers, even as the infection itself made migraines worse for those who caught it.

Newer Treatments for Stubborn Post-COVID Headache

Because there are essentially no randomized treatment trials specifically for long-COVID headache, doctors currently rely on the treatment guidelines that already exist for whichever primary headache type the patient’s post-COVID headache resembles. If it looks like a migraine, treat it like a migraine. If it looks like tension-type headache, start there.¹¹ That is an honest acknowledgment that the evidence has not caught up with the problem yet.

One emerging area of interest involves CGRP monoclonal antibodies, a class of injectable medications originally developed for migraine prevention. CGRP (calcitonin gene-related peptide) is a molecule involved in pain signaling along the trigeminal pathway, and given that COVID headache appears to involve trigeminal activation, targeting CGRP makes biological sense. In a small case series of nine patients with persistent headache following COVID, all of whom had failed conventional preventive therapies, treatment with a CGRP monoclonal antibody led to significant drops in monthly headache days (from a median of 25 to 5), pain severity, and medication use.¹² A separate case report described a patient with persistent post-COVID headache who became headache-free after four monthly doses of galcanezumab, another CGRP-targeting drug, with pain relief beginning within two days of each injection.¹³

These results are encouraging but based on very small numbers. Nobody should read them as proof that CGRP drugs work for every post-COVID headache. They do suggest that patients who have been suffering for months without relief from standard treatments have a reasonable option to discuss with a headache specialist, particularly when the headache has migraine-like features.

The Broader Toll on Daily Life

A headache that persists for weeks or months does not stay neatly in the “medical symptom” column. It bleeds into every part of daily life. Research on long-COVID patients has found that chronic pain, including headache, is strongly linked to poorer quality of life, with pain intensity and overall symptom burden both independently associated with worse outcomes. Employment status also matters: people unable to work because of their symptoms reported lower quality of life on top of the direct burden of the pain itself.¹⁴

Among healthcare workers in Portugal with long COVID, persistent symptoms were significantly associated with lower life satisfaction and reduced work performance, with extreme fatigue and cognitive dysfunction showing the strongest negative effects on how well people could do their jobs.¹⁵ Headache often co-occurs with these symptoms, and the combination can be genuinely disabling. People dealing with a persistent post-COVID headache alongside fatigue and brain fog are not being dramatic when they say they cannot function normally. The data backs them up.

What Biomarkers Might Tell Us

One of the frustrations with long-COVID headache is that standard imaging and blood work often come back normal, which can leave patients feeling dismissed. Researchers are working on identifying biomarkers that could objectively confirm what patients are experiencing. A systematic review of biomarkers in long COVID found that patients with neurological symptoms, including persistent headache, tended to show elevated levels of neurofilament light chain and glial fibrillary acidic protein, both of which are markers of nerve injury and brain-cell stress.¹⁶

These markers are not yet used in routine clinical practice for diagnosing post-COVID headache, and they require specialized testing that most primary care offices do not offer. But their elevation in patients with neurological long-COVID symptoms provides biological evidence that something measurable is happening in the nervous system, even when MRI scans look clean. As this research matures, it may eventually give doctors a way to stratify patients, identifying who has ongoing nerve-level inflammation and might benefit from more aggressive treatment versus who is likely to improve with time and standard care.

1
PubMed Central. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study
2
PubMed Central. Frequency and Type of Red Flags in Patients With Covid-19 and Headache: A Series of 104 Hospitalized Patients
3
PubMed Central. Activation of the trigeminal system as a likely target of SARS-CoV-2 may contribute to anosmia in COVID-19
4
PubMed Central. Cytokine storm induced by SARS-CoV-2 infection: The spectrum of its neurological manifestations
5
PubMed Central. A Review on Headaches Due to COVID-19 Infection
6
PubMed Central. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in COVID-19
7
PubMed Central. Persistent headache and chronic daily headache after COVID-19: a prospective cohort study
8
Frontiers in Pain Research. Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports
9
PubMed Central. Changes in Migraine Headaches Following SARS-CoV-2 Infection: A Case Series
10
PubMed Central. Overall trend towards headache remission during the COVID-19 pandemic among Chinese patients with pre-existing headache highlights the role of family support
11
PubMed Central. Long COVID headache
12
PubMed Central. Calcitonin Gene-Related Peptide Monoclonal Antibody Treatment in Nine Cases of Persistent Headache Following COVID-19-Infection
13
Frontiers in Pain Research. Is Persistent Post-COVID Headache Associated With Protein-Protein Interactions Between Antibodies Against Viral Spike Protein and CGRP Receptor?: A Case Report
14
PubMed. Determinants of quality of life in long-COVID patients with new-onset chronic pain
15
PubMed Central. The impact of long COVID on quality of life and work performance among healthcare workers in Portugal
16
PubMed Central. Biomarkers in long COVID-19: A systematic review