While loss of taste and smell are among the most publicized symptoms of COVID-19, headaches are also among the early symptoms. Often, those headache effects can linger.

Dr. Megan Donnelly

Dr. Megan Donnelly, a women’s neurologist and board-certified headache specialist at Novant Health Neurology and Headache - SouthPark in Charlotte, answers questions about COVID-19 headaches, neurological effects of the virus, and migraines in the time of a pandemic.

What is the connection between COVID-19 and headache?

From a headache perspective, this is one of the presenting symptoms of COVID-19.

This virus behaves differently than a lot of other viruses. And one of the first symptoms that people have, before they develop cough, is they will get anosmia, which is lack of sense of smell. They can get really bad headache at that time. Sometimes cough doesn't come until another couple of days later. There is a theory that this anosmia is actually due to the virus crossing over and invading the cribriform plate (near the nasal cavity) into their brain, causing a viral meningitis like picture.

What are other serious neurologic conditions might COVID-19 cause?

There are several. The more ominous things are encephalitis, seizures, increased risk of stroke and blood clot in the brain and hemorrhagic encephalitis.

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We’ve seen things like brain and spinal cord inflammation, a condition called ADEM (acute disseminated encephalomyelitis) and another that looks like a multiple sclerosis attack, which can include tingling, numbness, fatigue, cramps, tightness and dizziness, altered mental status, and seizure.

There is also a connection between COVID and lung failure.

What type of headache does COVID-19 cause, and how does it compare to a migraine?

I've seen patients while they're actively sick and also in follow-up, sometimes even months after recovering from COVID, who have post-COVID-19 headache. In some patients, the severe headache only lasts a few days, while in others, it can last up to months.

It is presenting mostly as a whole-head, severe-pressure pain. It's different than migraine, which by definition is unilateral throbbing with sensitivity to light or sound, or nausea. COVID headaches present more as a whole-head pressure.

What else should you be aware of?

I make sure I'm not missing one of the more ominous conditions. I often have to order imaging on these patients and they'll get an MRI to make sure we're not seeing stroke or encephalitis. I check venous imaging to make sure I'm not missing a clot in the veins. The reason for that is COVID patients have a tendency for blood clots.

There's a recommendation by the American Society of Hematology to add aspirin (81 mg) on a daily basis to anyone who is actively infected, to help decrease the risk of clots.

Sometimes, we recommend the drug gabapentin (300 to 900 milligrams, taken nightly) which can be helpful to patients with post-COVID lingering headaches, who we know have normal resolved brains, where we’re not seeing strokes encephalitis, clots or anything.

For someone whose migraines are triggered by stress, how do they deal with that during the lingering pandemic?

We're all weathering the storm and each person's weathering it differently in terms of the degree of stress they're facing. It could be a family member’s illness, or themselves, financial stressors, etc. There’s a lot on people's plates. Managing stress levels and focusing on mindfulness can be extremely important. And even I've even started doing more yoga, meditation and deep breathing exercises.

Sometimes that's not enough. Although I think that's an important first mainstay of treatment, we need to recognize when we need to treat patients with medication and with psychotherapy to help. If the stressors are the biggest cause of the uptick of headache, addressing stress and mental health, rather than just throwing more medications at the headache, is going to be extremely important. As with any health condition, treating the underlying cause of uptick is more important than putting a bandage on it.

Any general tips for someone concerned about headaches, whether they’ve dealt with migraine or fear it developing?

Continuing a healthy lifestyle is always going to be one of my top pieces of advice. Make sure you are getting enough sleep, that you're keeping a routine with your sleep. With the loss of many regular life activities, making sure you maintain a modicum of routine schedule is extremely important. Even if you’re at home, I recommend getting up at the same time that you used to, get dressed, eat meals, exercise and go to sleep at the regular times.

You can also find Dr. Megan Donnelly on Facebook.