Long covid
headache

Long-Covid headache is a symptom that occurs after a Covid-19 infection.

It can manifest as a new daily persistent headache (NDPH) or worsen existing headaches.

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Headaches after Covid-19 can be new or worsen existing headaches.

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The most common types are migraine, tension headache or new daily persistent headache (NDPH).

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Treatment includes both non-medical and medical treatment.

How common is Long-Covid headache?

Headache is a common symptom during the acute phase of Covid-19, with an incidence of 14-60%. Approximately 18% of patients continue to experience headaches after the illness.

Different types of Long-Covid headache

Headaches can be classified into three main groups or phenotypes:

  • Tension headache
  • Migraine-like headache
  • New daily persistent headache (NDPH)
Symptoms

The symptoms of Long-Covid headache include:

  • Bilateral pain
  • Intense pain in the forehead and around the eyes
  • Sensitivity to light and sound
  • Throbbing or pressing pain
  • Other symptoms that can occur at the same time include loss of sense of smell, low energy levels, breathing problems, muscle pain, coughing, cognitive problems, dizziness and sleep disorders.
What are the mechanisms behind Long-Covid headache?

The mechanisms behind Long-Covid headache include activation of the trigeminovascular system in genetically predisposed individuals, persistent activation of the immune system, and activation of the trigeminal nerve that sends pain signals to the brain.

How long does a bout of Long-Covid headache last?

The headache lasts an average of 14 days, but 15.4% of patients experience headaches after 9 months.

How often do Long-Covid headaches occur?

The headache can be episodic or constant.

What triggers an attack of Long-Covid headache?

Stress, little sleep, light and sound. Physical exertion can aggravate migraine-like headaches.

How is Long-Covid headache diagnosed?

The diagnosis is made based on the symptoms, the development of the headache in relation to Covid-19, and the exclusion of other causes.

Treatment

The treatment of Long-Covid headache can be both non-medical and medical. Non-medical treatments include neck and shoulder stretching, lifestyle changes, moderate aerobic exercise, breathing and relaxation techniques, cognitive behavioral therapy, and manual therapy/physiotherapy.
Medical treatments may include Paracetamol or NSAIDs, Triptans, indomethacin, tricyclic antidepressants, and botox injections, depending on the type of headache and subcategory/phenotype you have.

Prevention

Vaccination and a healthy lifestyle can reduce the risk of infection and serious long-term symptoms.

Differences and similarities between headache after Covid-19 infection and headache after Covid-19 vaccine:

Headache after Covid-19 infection:

  • Usually part of a complex of symptoms that last for at least 2 months.
  • May be a symptom of long COVID.
  • Indicates a previous Covid-19 infection.

Headache after Covid-19 vaccine:

  • Usually short-lived and transient.
  • In rare cases, it can be more persistent.
  • No official criteria for long COVID after vaccination, as this is an area under active research.

Common:

  • Both Covid-19 infection and vaccine can cause headaches.
  • Headaches are usually mild and go away on their own.
  • In case of prolonged or severe headaches, consult a doctor.

Important!

Diagnostic criteria from ICHD-3 for headache after viral infection:

  • A. Headache of any duration that meets criterion C.
  • B. Systemic viral infection has been diagnosed; no signs of meningitis or encephalitis.
  • C. Proof of causality with at least two of the following:
    • Headaches occur in the context of the viral infection.
    • The headache worsens with the worsening of the infection.
    • The headache improves with the improvement of the infection.
    • The headache is diffuse or moderate to severe in intensity.
  • D. Not better explained by another ICHD-3 diagnosis.
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