People living with Long COVID frequently report headaches as a symptom. The types of headaches that occur can be very variable, and can be difficult to describe as they might be very different from headaches that people have had in the past.
Headaches are a worrying symptom, particularly if they are interrupting the ability to continue with normal activities. However, headaches are not usually dangerous, and will improve with simple measures, such as staying hydrated, taking simple analgesia, accessing fresh air, and getting enough rest. It is common that a few of these things going out of balance will lead to a headache. Only very few headaches are caused by something that can be seen on a scan.
There are two situations where more urgent medical attention may be required. These are where a headache comes on very suddenly (over a second or two) or where the headache is the very worst that you have experienced. In these cases, seeking medical attention at the time is advised.
Our clinic has noticed that many of the headaches described by our patients fit into a category of headache called migraine. Contrary to popular belief, there is no such thing as a “typical” migraine, and where someone may have had migraines in the past, COVID appears to influence these, and there can be new or altered features compared to those experienced before a COVID illness. Migraine headaches are often associated with some warning symptoms, and in particular visual disturbances (like flashing lights, or blurring of the vision.) Migraine often affects one side of the head, but this is not always the case.
- Try to maintain a good sleeping pattern
- Maintain good hydration
- Eat small, frequent meals
- Aim to get regular fresh air and exercise
- Avoid prolonged exposure to computer screens
- If you have noticed any change in your vision, seek an appointment at an optician for an eye test.
Some people know their triggers - if you do then do your best to avoid them.
- Magnesium supplements 400-600mg every day
- Riboflavin supplements (vitamin B2) 400mg if possible
These are easier to buy from a chemist, supermarket or health food shop rather than get prescriptions for. In general, a supermarket is cheaper.
Rescue treatment includes the usual painkillers paracetamol and ibuprofen. Naproxen is usually more potent than ibuprofen but requires a prescription. These treatments can be useful on occasions, but all have side effects. Nonsteroidal anti- inflammatory medications such as ibuprofen / naproxen can cause stomach disturbance if taken for more than a few days.
Some of these medicines can risk analgesic overuse headache if taken more than twice in a week. Taking pain killers alongside an anti-sickness medicine such as prochlorperazine or metoclopramide is helpful if feeling sick is an issue.
You may wish to put in a sentence about triptans.
Other acute treatment of migraine attacks include a type of medication called triptans. These have to be prescribed by a doctor and should not be taken more than ten days per month. They should be taken as early in the headache cycle as possible to reduce the duration and severity of the headache attack.
If you suffer with regular disabling headaches, it may be better to use a preventative medication. You can discuss these with doctors either in the Post-COVID clinic, or with your GP. The principles of medication use in post-COVID headaches are the same as routine management of headaches, which is a very common problem seen by GPs.
A headache diary is important to record how many episodes you have, how severe they are, and if there were any triggers or situations where they came on.
Treatments to prevent headaches typically take 6-8 weeks to reach their best effect, and so a diary is helpful to be able to look back and see if there has been any change over time. Our memory is very good at tricking us with things like headaches, and so just trying to remember if things have helped without the assistance of a diary can be difficult.
If you take painkillers for headache, take them early, at the highest possible dose for your age. Treating them early and hard is more likely to stop a headache, and avoid lots if extra painkillers alter in the day.
If you feel sick with your headaches, try some plain salty foods (like crackers) to help with the nausea.
As much as possible, keep going with your day - having things to do means we are less likely to notice the headache and therefore it is likely to go away! If it's really bad, then you can rest.
Some people find yoga or mindfulness helpful when they have a headache -YouTube has some videos (like yoga for Adrienne headache video) that can help.
Mindfulness helps you breathe through what is happening, notice it, but not get too focused on it. They both improve blood flow, and we know how we manage our mood and emotions also impacts on headaches.
- Migraine Trust: www.
migrainetrust.org/ - Head smart: www.
headsmart.org.uk/ - Healthy London Partnership: https://what0-18.nhs.uk/parentscarers/worried-your-child- unwell/headache
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Page last updated: 21 May 2024
Review due: 31 October 2025