Migraine and Post-COVID Headache

Learn about post-COVID headache symptoms, treatments and how it affects those living with migraine.

With the alpha, delta and omicron variants, headache has been a common symptom of SARS-CoV2 (COVID-19). However, a headache that doesn’t go away after having COVID-19 could be a sign that you’re fighting post-COVID headache.

Although it seems like the pandemic has been with us forever, in medical terms, it is too soon to make any predictions about the characteristics and treatment of the headache that COVID-19 causes with much certainty. Headache is a common feature during acute illness, and it is not surprising since headache often accompanies many viral illnesses.

Post-COVID headache is a persistent headache that develops after having COVID-19. Symptoms can last for weeks or even months after testing negative for the virus. Though anyone can develop post-COVID headache, people with migraine are more likely to see an increase in the frequency and intensity of their migraine attacks.

We spoke with Dr. Chia-Chun Chiang, Senior Associate Consultant and Assistant Professor of Neurology at Mayo Clinic in Rochester, Minnesota, to learn more about the symptoms, treatments and research on post-COVID headache.

Symptoms of Post-COVID Headache

“Most of the time, post-COVID headaches are described as migraine-like headaches,” says Dr. Chiang. “The headache can present like a migraine attack.” People with post-COVID headache typically experience a throbbing pain on one side of their head. Alongside this pain, some people have sensitivity to light and noise and sometimes to touch or smell.

Dr. Chiang says there are many ways people experience and describe post-COVID headache. “For some patients, they experience a headache after COVID infection that is described as a mild, dull headache that goes away,” she says. Other patients experience a “debilitating, worst headache of their life, and it’s…a daily persistent headache that lasts for a long time.”

Timeline of Post-COVID Headache

Dr. Chiang says that about 47% of patients have gone on to develop a headache following a COVID infection. Most people see their headache clear up after two months, and even fewer experience symptoms after three months. However, some people may continue to feel the effects for even longer. “In about 8% of patients, headache can persist even six months after COVID-19 infection,” she says. “It can certainly be a very debilitating symptom for our patients.”

Headache During and After COVID-19 Infection

Migraine-like head pain is the most common description of a headache caused by COVID-19. Dr. Chiang says that generally, people describe a more severe headache during an active COVID infection. This can come with sensitivity to light or noise and worsen with other COVID symptoms like fever and respiratory symptoms. She says most people have a milder, dull headache after their COVID infection.

“Studies have reported that sometimes headache can occur, not during the acute [illness] phase, but there can be a delayed onset of headache as well,” says Dr. Chiang. “So maybe during the acute phase, patients can have fever, shortness of breath and those types of respiratory symptoms. However, several weeks, or even several months later, they can have this headache that can be quite debilitating and persistent.”

Post-COVID Syndrome

Some people experience what doctors call post-COVID syndrome, or less formally long COVID. These are long-term symptoms that can continue even after testing negative for COVID-19. Individuals who experience post-COVID syndrome are often referred to as COVID “long-haulers.” Dr. Chiang says people suffering from post-COVID syndrome can experience a lot of other symptoms in addition to headaches, including:

  • Insomnia
  • Difficulty with speech
  • Memory problems
  • Heart palpitations
  • Dizziness
  • Lightheadedness
  • Brain fog

How does post-COVID headache affect those with migraine?

Studies show that people with migraine are more prone to develop post-COVID headache when compared to those without a history of migraine. Patients with a history of migraine also see an increase in migraine attacks after having COVID.

“In the past, they only had one migraine attack per month. And after COVID infection, they can have a long debilitating headache that lasts for one or two months,” says Dr. Chiang. “After that, they can have very frequent migraine attacks, you know, 10, 15 attacks per month. So, COVID has certainly been reported to be associated with what we call migraine chronification or worsening of migraine.”

Post-COVID Headache Study

A recent study published in the American Headache Society’s “Headache: The Journal of Head and Face Pain” looked at three different cases of migraine-like headaches in people with a history of COVID-19 infection.

We summarized them to highlight the range of post-COVID headache experiences and remind you that if you’re going through this, you are not alone.

Patient 1: Migraine Chronification

A 56-year-old woman with a personal and family history of low-frequency episodic migraine—one migraine a month, lasting for less than a day—experienced a mild case of COVID-19. Her first symptoms were headache, loss of smell and taste and general discomfort. During the post-COVID phase, she experienced additional symptoms, including tiredness, sensitivity to touch and difficulty sleeping. She received a treatment of amitriptyline— a nerve pain medication originally used to treat anxiety and depression—and saw an improvement in her sleep quality; however, a daily headache, with less intensity, continued. OnabotulinumtoxinA (Botox®) was added to her treatment, and she noticed fewer headaches and a return to her usual migraine.

Patient 2: Long-lasting COVID Headache

A 55-year-old woman with no personal or family history of migraine reported a mild case of COVID-19. Her first symptoms included loss of smell and taste, cough, shortness of breath, general discomfort and diarrhea. A persistent headache started a few days after other symptoms. The patient described it as moderately severe across all of her head with moments of severe throbbing. She went on to experience tiredness and difficulty sleeping post-COVID. She received a treatment of amitriptyline and onabotulinumtoxinA, much like Patient 1. After three months of treatment, she saw improved sleep quality and fewer, less intense headaches.

Patient 3: Delayed-Onset-COVID Headache

A 44-year-old man with no personal or family history of migraine experienced a daily, constant post-COVID headache along with tiredness and difficulty sleeping. He received a treatment of amitriptyline for his difficulty sleeping and candesartan for his high blood pressure. Five weeks later, his high blood pressure improved, and his sleep quality had improved; however, there were no changes in his headaches. He received a treatment of onabotulinumtoxinA but saw no improvement after two cycles. A prescription of rizatriptan followed, but he began reporting additional symptoms, including thinking problems, memory loss, heart palpitations and dizziness. On the patient’s last visit, he was still experiencing daily, severe and consistent headaches that kept him from returning to work and his usual activities.

Treatments for Post-COVID Headache

At this time, it is too early to predict the duration, severity and accompanying symptoms, nor recommend the appropriate treatments for headache associated with COVID-19. Many patients with a history of migraine report having a headache that mimics their migraine but doesn’t respond to their usual medications. Others report their COVID-related headaches are different—either more severe or longer-lasting.

Oftentimes, people reach for over-the-counter medications to treat headaches quickly. However, frequent use of these medications could result in medication overuse headache. It’s best to talk with your doctor and share all your symptoms to find a long-term solution, as treatments for post-COVID headache depend on a person’s unique situation.

“If they also have other symptoms, for example, difficulty falling asleep or memory problems, we can consider those symptoms when we choose medications as well,” says Dr. Chiang. “In general, when patients describe migraine-like headache after COVID infection, we would recommend migraine therapies.”

The best preventive action against COVID infection and, therefore, post-COVID headache is the COVID-19 vaccine. Though the vaccine can trigger a migraine attack, the result of catching COVID-19 without a vaccination could prove much worse, says Dr. Chiang. “Although there’s a small chance that the vaccine could potentially trigger migraine, if you don’t get vaccinated, the COVID infection itself can trigger a worse headache.”

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.

Investigators across the country are collecting and analyzing data to better understand the impact for those living with migraine or those who may have developed headache as a long-haul symptom after COVID-19 infection. Like much about this novel disease, there are many more questions than answers. But be assured that AMF will keep you updated as new evidence is uncovered. Avoiding COVID-associated headache is another reason to get vaccinated if you haven’t already and get boosted when eligible.

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.