Webinar Recap: Migraine and COVID-19 Update

Learn what researchers have discovered about post-COVID headache and how this long-COVID symptom impacts people with migraine and headache disorders.

Since the start of the COVID-19 pandemic in 2020, researchers have been working to fully understand its long-term effects. Post-COVID headache is an especially common concern for people who live with migraine and other headache disorders. We hosted a webinar highlighting research on the impact of COVID-19 on migraine and headache, including updates on a few promising treatment studies.

The webinar featured Dr. Teshamae Monteith, Associate Professor of Clinical Neurology, University of Miami, Miller School of Medicine; Dr. Chia-Chun Chiang, Assistant Professor of Neurology, Mayo Clinic; and Karyn Bishof, long-COVID patient and Founder and President of the COVID-19 Longhauler Advocacy Project.

What do long-COVID symptoms look like?

Bishof shares that, prior to her March 2020 COVID-19 infection, she was healthy and working as a South Florida firefighter paramedic. Her COVID-19 infection started as a mild to moderate case that did not require hospitalization and seemed to be running its course in a matter of weeks. There was a brief period when Bishof felt like she was improving, but then her symptoms returned and increased between weeks five and eight. 

Common post-infection symptoms of COVID-19 include fatigue, shortness of breath and cognitive impairment (the “brain fog” many report experiencing after recovery). Additionally, post-COVID headache is a common symptom for people who experience lingering effects in the months and years following infection. 

Since March 2020, Bishof has experienced headache symptoms virtually every day. “I’m not unique in this regard,” she says. “In the long-COVID phase, headache is now considered the fifth most common symptom, and this can refer to either a new-onset headache or a worsening of a preexisting headache.”

How do doctors diagnose long-COVID headache?

Chiang explains that there are several phases of headache attributed to COVID-19. The acute phase refers to headache that starts between the onset of COVID symptoms and week four. Weeks five to 12 are considered the post-acute phase, and beyond 12 weeks is characterized as the ongoing symptomatic phase.

When diagnosing long-COVID headache, Chiang notes that doctors will first rule out other possible secondary headache disorders: “For example, there are several vascular conditions like cerebral venous sinus  thrombosis, which is a blood clot in the brain,” she says. Certain types of strokes have also been reportedly associated with COVID-19. “So, those conditions have to be ruled out with MRI and vessel imaging,” Chiang says.

She adds that COVID-19 infection can also affect a preexisting primary headache disorder. “A lot of patients had migraine before the pandemic and now after either a COVID infection or stress associated with the pandemic, their migraine got significantly worse,” she says.

How common is headache after a COVID-19 infection?

Chiang says that approximately 50% of patients experience headache with COVID during the acute phase of infection. Headache is reported in around 30% of patients one month after COVID-19. After nine months, about 16% of patients report headache. Headache in the acute and post-acute phases is more commonly seen in women, and headache in the acute phase is more common in younger patients.

What are common long-COVID headache symptoms?

Many researchers believe COVID headache is caused by a persistent, long-term activation of the immune system. “COVID headache can follow a migraine pattern or present as a tension headache,” Bishof says. “This is typically experienced as daily persistent headache. This ongoing presentation, along with its lack of response to typical headache treatments, makes COVID headache one of the most debilitating symptoms long-haulers can experience.”

Patients have described the pain of long-COVID headache as pressing, throbbing and of moderate to severe intensity. Most experience pain on both sides of the head, and many experience abnormal sensitivity to light or sound, similar to migraine symptoms.

“There are also studies reporting that several symptoms can be associated with [long-COVID] headache,” says Chiang. “In the acute phase, loss of smell and loss of taste are significantly associated with headache, [while] brain fog and insomnia have been found to be significantly associated with persistent headache after a COVID infection.”

Can COVID-19 contribute to more frequent migraine attacks?

Chiang explains that for some people, COVID-19 may contribute to an increased frequency of migraine attacks, including cases where episodic migraine develops into chronic migraine following a COVID infection. “It is very important to intervene early and treat aggressively to reduce the possibility of developing more frequent or chronic migraine after COVID infection,” she says.

Monteith notes that while we don’t currently have data to show that patients with COVID have a higher likelihood of transitioning from episodic to chronic migraine, there is clinical evidence of this progression. “We’re seeing that in our clinics where our patients are coming in, their migraine was well controlled, they got COVID-19 and at least a subset develop chronic migraine,” she says. “And I think that is in line with the World Health Organization definition [of post-acute COVID symptoms].”

Can COVID-19 vaccinations cause headache?

Monteith says that headache is a common symptom of vaccination. “It’s actually a symptom you want to have. It shows that your immune system is responding to the vaccination,” she says. “And by and large, most patients’ symptoms are mild, with very rare cases that are considered moderate or severe. In addition, headache may rarely persist as a complication after a vaccination and is often treatable.”

What treatments are available for COVID-19 headache?

Treatment of post-COVID headache is symptomatic and may sometimes require treatment from a specialist. Chiang notes that more research is needed on treatments for headache associated with COVID-19. “But there are several studies that reported that for acute treatment, there can be potential improvement with corticosteroids,” she says. “Another case series suggested that a greater occipital nerve block could be helpful for those who previously did not respond to oral medications such as acetaminophen.”

Dr. Monteith says that “preventive therapy may be indicated for frequent and prolonged cases, especially including non-specific treatment such as tricyclic antidepressants or possibly newer treatments such as drugs that target a protein known as calcitonin-gene related peptide, although clinical trials are needed.”

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.