A migraine is a type of severe headache that often includes throbbing pain, typically on one side of the head. It can be accompanied by other symptoms such as increased sensitivity to light and sound, and nausea. COVID-19, caused by the SARS-CoV-2 virus, is a respiratory illness recognized for its wide array of symptoms that can affect various body systems.
Migraine as an Acute COVID-19 Symptom
Headaches are a common symptom during the initial phase of a COVID-19 infection. About half of individuals with COVID-19 report experiencing a headache. For some, it can be the first or only symptom. These headaches are often described as moderate to severe, with a throbbing or pressure-like sensation.
The pain can be felt across both sides of the head or primarily in the forehead or temples. While some COVID-19 headaches might feel like tension headaches, others can present with pulsing pain, often on one side, similar to a migraine. Pain may worsen with movement, coughing, or physical activity, and may include sensitivity to light and sound. Typically, these acute COVID-19 headaches resolve within a few days, though some may last longer.
Why COVID-19 Can Cause Migraines
The exact reasons why COVID-19 triggers headaches are still being investigated, but several mechanisms are proposed. A primary factor is the body’s inflammatory response to the virus. When the immune system combats the infection, it releases inflammatory mediators called cytokines. This “cytokine storm,” an exaggerated immune response, can lead to widespread inflammation, including within the brain’s blood vessels and nerves, activating pain pathways and causing headaches.
The SARS-CoV-2 virus can also directly affect the nervous system. The virus may activate the trigeminal nerve or affect the central nervous system through pathways like the olfactory bulb. The virus can also cause vascular changes, contributing to headache development. Hypoxia, or low oxygen levels, can also induce neuroinflammation and headaches.
Migraines in Long COVID
Beyond the acute phase, migraines can persist or emerge as part of “Long COVID.” Some individuals experience new or worsening headaches weeks or months after the initial infection has cleared. These post-COVID headaches are characterized by throbbing pain, sometimes on one side of the head, and sensitivity to light and noise. Studies show that up to 50% of patients report persistent headaches 12-15 months post-infection.
For individuals with a history of migraines, COVID-19 infection can increase the frequency and intensity of their migraine attacks. In other cases, individuals with no prior history of headaches might develop a new daily persistent headache after COVID-19, which can be debilitating. These persistent headaches often coexist with other long COVID symptoms such as fatigue, brain fog, and sleep problems, indicating a complex neurological impact.
When to Consult a Doctor for Migraines
While headaches are common, it is important to seek medical attention for certain symptoms. You should consult a healthcare provider if your headaches are frequent, more severe than usual, or do not improve with over-the-counter pain relievers. If headaches disrupt your daily activities, sleep, or work, professional guidance can be beneficial.
Immediate medical evaluation is necessary for “red flag” symptoms. These include a sudden, severe headache described as the “worst headache of your life,” a headache accompanied by a stiff neck, fever, or confusion. Other concerning signs are headaches with new speech problems, vision changes, weakness or numbness on one side of the body, or a headache that begins after a head injury. Any new headache in individuals over 50 years old or headaches that worsen with coughing or lying down also require prompt medical assessment.