A new or unusual headache is a well-documented symptom of a COVID-19 infection. For many, a headache is one of the first signs of the illness, appearing early with other symptoms like fever or a cough. These headaches can vary in intensity, ranging from a dull, persistent pressure to severe, debilitating pain.
Identifying a COVID-Related Headache
A headache connected to a COVID-19 infection often presents with distinct, migraine-like qualities. Many people report a moderate to severe throbbing or pulsating pain across the entire head or localized to one side. This pain is frequently described as intense pressure around the temples or behind the eyes and may worsen with movement, coughing, or physical exertion.
Unlike a typical tension headache, a COVID-related headache is often accompanied by other symptoms commonly associated with migraines. These can include a heightened sensitivity to light, known as photophobia, and an increased sensitivity to sound, or phonophobia. Nausea and vomiting may also occur alongside the head pain.
For a significant number of individuals, the headache that accompanies a COVID-19 infection may be their first experience with this type of severe, migraine-like head pain. The pain tends to develop quickly after infection and can be resistant to standard over-the-counter pain relievers, often recurring after the medication wears off.
Neurological Impact of the Virus
The SARS-CoV-2 virus can trigger severe headaches through its effects on the nervous system. One primary mechanism involves the body’s immune reaction to the infection. As the immune system fights the virus, it releases inflammatory proteins called cytokines. This can lead to widespread inflammation that affects blood vessels and nerves in the brain, resulting in pressure or throbbing pain.
In some instances, the virus may have a more direct impact. Evidence suggests that SARS-CoV-2 can invade nerve cells, potentially through the nasal cavity, and directly activate the trigeminal nerve system. This system is a network of nerves that plays a central role in the development of migraines. Activation of these nerves can cause the release of pain-inducing neurotransmitters, leading to headache symptoms that mimic a migraine attack.
Another contributing factor can be a decrease in oxygen levels in the blood, a condition known as hypoxemia, which can result from the virus’s effect on the lungs. This shortage of oxygen can also be a source of head pain.
Long-Term Headaches After Infection
For some individuals, headaches do not end when the acute phase of the COVID-19 infection resolves. They can persist for weeks or even months, becoming a primary symptom of Long COVID or Post-Acute Sequelae of COVID-19 (PASC). This phenomenon can occur even in people who only experienced a mild initial illness.
These persistent headaches can manifest as a chronic version of the migraine-like pain experienced during the initial infection. In other cases, individuals may develop “new daily persistent headache” (NDPH). NDPH is characterized by a continuous, daily headache that begins on a distinct day and does not ease, a pattern that some people report starting with their COVID-19 infection.
Living with a constant or frequently recurring headache can have a substantial impact on a person’s quality of life and ability to function.
Management and Treatment Approaches
Managing a headache associated with COVID-19 often begins with simple, at-home care. Rest and staying well-hydrated are fundamental, as dehydration can worsen headache pain. If you are sensitive to light and sound, resting in a quiet, dark room may provide some relief. Applying a cold compress to the forehead can also help soothe the pain.
Over-the-counter (OTC) medications are a common first line of defense. Pain relievers such as ibuprofen (Advil) and acetaminophen (Tylenol) can be effective for mild to moderate pain. It is important to follow the dosage recommendations on the packaging, especially since some multi-symptom cold medications also contain these ingredients.
If the headache is severe, persistent, or does not respond to OTC options, consulting a healthcare professional is necessary. A doctor can provide a proper diagnosis and may recommend prescription-strength treatments. For headaches with migraine-like features, medications such as triptans might be prescribed. In cases of long-term or chronic headaches, other medications, including certain antidepressants, may be considered to help manage the persistent pain.