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photo shows a woman holding her temples in pain. There is red and lightning bolts near her forehead

If you live with migraine, every day can already feel unpredictable: Will a late lunch trigger a day-long episode? Will a restless night lead to an excruciatingly painful day?  

Throw the still ambiguous effects of long COVID into the mix, and things can seem even more unclear. One in every eight patients is affected by persistent symptoms after COVID-19, according to a 2022 study in The Lancet — and experts are still learning more about the effects of long COVID and migraine, specifically.  

In a 2021 meta-analysis published in Scientific Reports, researchers found that the most common long-term symptom in patients with COVID-19 was fatigue (58 percent), followed by headache (44 percent).  

Another 2021 study published in Annals of Clinical and Translational Neurology found that the following neurologic manifestations were most common:  

  • Brain fog (81 percent) 
  • Headache (68 percent) 
  • Numbness/tingling (60 percent) 
  • Altered taste (59 percent) 
  • Loss of smell (55 percent) 
  • Muscle aches/pains (55 percent)

Here’s what to know about the research behind long COVID and migraine, plus what to do if you experience migraine after being infected.  

Differentiating Between COVID-19 Symptoms and Long COVID

Head pain is the most common neurological symptom associated with COVID-19 infection, per a 2022 study in the journal Cureus. Headaches identified with COVID-19 are mostly migraine, tension-type headaches, or cough headaches located in the front or back of the head. 

“Headache is a fairly common symptom of COVID and sometimes it’s the most prominent symptom of COVID,” says Matthew Robbins, MD, a neurologist at Weill Cornell Medicine.  “Often, a headache can really outlast the viral presence itself.” 

For decades, researchers have also known about a condition called new daily persistent headache. Experts suspect that this condition, in which moderate to severe symptoms start suddenly, is caused by triggers like infection. People often develop new daily persistent headaches when they have a viral or bacterial infection such as COVID-19, Epstein-Barr virus (a key cause of “mono”), salmonella, E. Coli, and meningitis, per the Cleveland Clinic 

Then, of course, there’s headache as a symptom of long COVID. However, it can be difficult to parse out if head pain is a result of long COVID or something else.  

“Headache is just so common overall,” says Dr. Robbins. “And 12 percent of people have migraine in any given year, which is a lot. So sometimes, because it’s so common in the first place, it’s hard to show that signal in long COVID — but it does happen.”  

A migraine is a headache that causes severe throbbing pain or a pulsing feeling, typically on one side of the head, per the Mayo Clinic. It often occurs with nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours or up to days and the pain can be extremely severe and interfere with your daily life.  

Factors That May Cause Migraine in Long COVID

There could be three potential causes of migraine related to long COVID, says Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University:  

  • The binding of viral spike protein to receptors in the brain and spinal cord 
  • Systemic inflammation caused by COVID-19 that could lead to headaches 
  • Release of other chemicals due to inflammation caused by COVID-19 or directly due to COVID-19 infection  

“There are many potential mechanisms that make a lot of biological sense,” says Dr. Khubchandani.  

In a recent 2023 pre-print study (meaning it hasn’t been peer-reviewed yet) posted on bioRxiv, hyperinflammation was involved in triggering the onset of post-COVID-19 condition-associated headache symptoms. Researchers note that sustained inflammation potentially contributes to the development of persistent long COVID headaches. 

In the case of autoimmune activation with inflammation, other parts of your body may be affected, too. 

“The same thing could happen in joints and in other parts of the body,” says Dr. Robbins. “It could be that COVID itself leads to some autoimmune activation with inflammation or release of molecules called cytokines that could be in the nervous system and lead to pain.” 

You may also be prone to migraine after COVID-19 if you have a family history of it.  

“One thing that I’ve seen with people who don’t really have a history of migraine but then they develop COVID, and then they develop headaches that are frequent thereafter that resemble migraine, is that you often find they had a migraine family history,” says Dr. Robbins.  

Meanwhile, a 2021 study found that migraine patients may have a higher risk of COVID-19 in general. Participants with migraine reported a higher incidence of COVID-19 and heightened COVID-19 symptoms, but they were also less likely to access health care than people without migraine. 

What If You Already Had Migraine Before COVID-19?

People who have migraines may experience worsening pain with long COVID.  

“Often, for people who already have migraine, it is triggered during a COVID infection,” says Dr. Robbins. 

Those who had occasional headaches or episodic migraine before may develop more chronic migraine with long COVID. Plus, some people may witness new onset migraines (one of the most common types of headaches reported after COVID-19 infection).  

“It depends on a person’s profile, risk of headaches, and a variety of other factors like chronic disease history, lifestyle, and so forth,” says Dr. Khubchandani. 

What to Do If You Start Getting Headaches After COVID

It’s difficult to predict who will have new onset headaches and migraines after COVID-19 infection, so the best course of action you can take is to monitor your symptoms and stay in close contact with your doctor.  

“Timely detection of migraines and long-lasting headaches is key to profile a person’s headache characteristics after COVID-19 infection,” says Dr. Khubchandani. 

Your health care provider may prescribe treatment if you develop migraine attacks. People respond well to traditional migraine treatments if they have long COVID-related migraines, adds Dr. Khubchandani.  

Common preventive treatments for migraine are those often used for other medical purposes as well — such as blood pressure drugs, antidepressants, or epilepsy medications, per Johns Hopkins Medicine. 

“A sizable minority of people can transform migraine into chronic migraine, which is something that we absolutely need to prevent,” says Dr. Robbins. “It’s very important to identify and very closely follow up people who get COVID and experience headaches, or who have migraine that might be frequent already, to be on top of this.” 

In general, maintaining a healthy lifestyle is also helpful for managing migraine attacks. In fact, frequent migraine that is accompanied by neurological symptoms is best treated preventively and usually with a combination of dietary modification, lifestyle changes, vitamins, and daily prescription medications, per Johns Hopkins. 

You may find it helpful to keep a symptom log: The good news is that in many cases, headaches may go away with time, says Dr. Khubchandani. However, it’s important to keep in touch with your doctor about changing symptoms.  

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Hear From Experts and Patients Living with Migraine

Talking Head Pain is a podcast that confronts head pain, head on. Brought to you by the Global Healthy Living Foundation and hosted by migraine advocate Joe Coe, this show explores how people living with migraine, cluster headache, and other types of intense pain find ways to better manage their disease. Listen here for a special episode on Migraine and COVID.

Ballering AV, et al. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. The Lancet. August 6, 2022. doi: https://doi.org/10.1016/S0140-6736(22)01214-4. 

Daripa B, et al. Unusual Presentation of COVID-19 Headache and Its Possible Pathomechanism. Cureus. September 2022. doi: https://doi.org/10.7759/cureus.29358. 

Foo S, et al. Immunometabolic rewiring in long COVID patients with chronic headache. bioRxiv. March 6, 2023. https://doi.org/10.1101/2023.03.06.531302. 

Graham EL, et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers.” Annals of Clinical and Translational Neurology. March 23, 2021. doi: https://doi.org/10.1002/acn3.51350. 

Interview with Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University. 

Interview with Matthew Robbins, MD, a neurologist at Weill Cornell Medicine. 

Lopez-Leon S, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Scientific Reports. August 9, 2021. doi: https://doi.org/10.1038/s41598-021-95565-8. 

Migraine. Mayo Clinic. July 2, 2021. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201. 

Migraine Headaches. Johns Hopkins Medicine. Accessed May 18, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/migraine-headaches. 

New Daily Persistent Headache (NDPH). Cleveland Clinic. August 31, 2022. https://my.clevelandclinic.org/health/diseases/24098-new-daily-persistent-headache-ndph. 

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