Post-Covid Headache: Symptoms, Causes and Treatments

By Thomas Berk, MD, Medical Director of Neura Health

Since the pandemic began, we have been witnessing many different neurologic manifestations of SARS-CoV-2. Unfortunately, many clinical providers are still baffled by this condition. We wish we knew more about how it works but it’s still very early. The science is evolving as the virus changes, and the societal impact of vaccines has to be taken into account.  Patients who have been infected with Covid often complain of brain fog, depression/anxiety, shortness of breath, insomnia and headaches, among many other symptoms. 

Post-Covid Syndrome

Known as “Long Covid”, this set of symptoms can continue even after testing negative for the virus. Patients with post-Covid syndrome, can experience many neurologic symptoms including: 

• Brain fog

• Depression/anxiety

• Shortness of breath

• Dizziness

• Insomnia 

• Headaches 

Prevalence of Post-Covid Headache

The exact percentage of people infected with Covid who experience headaches varies by the study. The American Migraine Foundation says that 47% of patients have gone on to develop a headache following a Covid infection, with about 8% of them experiencing headaches that persist even 6 months after the infection. 

Symptoms of Post-Covid Headache

There are differences from patient-to-patient, but post-Covid headache tends to present similarly to a migraine attack because it worsens with exertion. The throbbing pain might be unilateral or switch from one side to another, and, like migraine, it often has sensitivity to light and sound, and sometimes to smell or touch. Nausea is also not uncommon. 

It’s likely a post-Covid headache if you’ve had Covid-19 or the vaccine and you continue to experience headaches, especially if you never experienced them before your infection, or if you did have them before your infection, they have changed significantly.

Studies show that migraine patients are more likely to develop post-Covid headache than people without a history of migraine. Migraine patients may also see an increase in migraine attacks after having Covid.

Treatments for Post-Covid Headache

Although we are a few years into this pandemic, it is still challenging to treat many post-Covid headache symptoms. Data is still emerging and there is significant variability from patient to patient.  For this reason, it’s also difficult to predict the severity or duration of post-Covid headache. Some patients with a history of migraine tell us that their post-Covid headache is similar to their migraine but doesn’t necessarily respond to their typical migraine medications.  Other patients report their COVID-related headaches are different—either they last longer or are more severe.  This is why individualized treatment is so important. 

Some other post-Covid symptoms can improve with a short steroid course, and many headache symptoms can improve with this as well.  This is often considered the first line treatment for post-Covid headache, but it can become somewhat more complicated if this initial course is not entirely effective. 

It can often be difficult to distinguish features of headache that you might be experiencing after Covid. The general consensus among specialists that treat post-infectious headaches is to consider using treatments that are effective for the subtypes of headache the patient appears to present with.  For example, if there are more features of migraine (throbbing, light and sound sensitivity and nausea) we would consider both preventive and acute medications for migraine, and if there are features of tension type headache or another unique headache type, we would treat for those specific symptoms.  

Not all doctors are as familiar with the subtleties, and if your headaches are difficult to treat, or have not responded to initial treatments, you should consider seeking out the opinion of a headache specialist to reevaluate your treatment options. 

Despite the fact that other Long Covid symptoms are often neurological in nature, seeing a headache specialist for Post-Covid Headache is typically going to be more helpful than seeing a general neurologist. Headache specialists are trained neurologists who have deeper knowledge of headache medicine as it’s all they treat. They are familiar with all the latest research and treatment options. 

A headache specialist would meet with you, talk through your health history, discuss all your other symptoms, and come up with a treatment plan to try based on your individual situation. If you don’t have a headache specialist, you can meet with one via a virtual appointment using Neura Health.

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Brought to you by ProMedView, connecting the dots of long COVID through education, research, and resources.

June 11, 2021, updated May 16, 2024