Long COVID and New Migraines: What's the Link?

Lisa Mulcahy

September 07, 2023

Editor's note: Find the latest long COVID news and guidance in Medscape's Long COVID Resource Center.

Intense throbbing, sensitivity to light and sound, nausea: these were the symptoms Nathan Solomon experienced during his first-ever migraine about a month after receiving a diagnosis of long COVID.

"I've also noticed visual disturbances, like flickering lights or blurred vision, which I later learned are called auras," the 30-year-old medical billing specialist in Seattle told Medscape Medical News.

Solomon isn't alone. It's estimated that 1 out of 8 people with COVID develop long COVID. Of those persons, 44% also experience headaches. Research has found that many of those headaches are migraines — and many patients who are afflicted say they had never had a migraine before. These migraines tend to persist for at least 5 or 6 months, according to data from the American Headache Society.

What's more, other patients may suddenly have more frequent or intense versions of headaches they've not noticed before.

The mechanism as to how long COVID could manifest migraines is not yet fully understood, but many doctors believe that inflammation caused by the virus plays a key role.

"To understand why some patients have migraine in long COVID, we have to go back to understand the role of inflammation in COVID-19 itself," says Emad Estemalik, MD, clinical assistant professor of neurology at Cleveland Clinic Lerner College of Medicine and section head of headache medicine at Cleveland Clinic.

In COVID-19, inflammation occurs because of a cytokine storm. Cytokines, which are proteins essential for a strong immune system, can be overproduced in a patient with COVID, which causes too much inflammation in any organ in the body, including the brain. This can result in new daily headache for some patients.

A new study from Italian researchers found that many patients who develop migraines for the first time while ill with long COVID are middle-aged women (traditionally a late point in life for a first migraine) who have a family history of migraine. Potential causes could have to do with the immune system remaining persistently activated from inflammation during long COVID, as well as the activation of the trigeminovascular system in the brain, which contains neurons that can trigger a migraine.

What Treatments Can Work for Migraines Related to Long COVID?

Long COVID usually causes a constellation of other symptoms at the same time as migraine.

"It's so important for patients to take an interdisciplinary approach," Estemalik stresses. "Patients should make sure their doctors are addressing all of their symptoms."

When it comes to specifically targeting migraines, standard treatments can be effective.

"In terms of treating migraine in long COVID patients, we don't do anything different or special," says Matthew E. Fink, MD, chair of neurology at Weill Cornell Medicine and chief of the Division of Stroke and Critical Care Neurology at New York–Presbyterian Hospital/Weill Cornell Medicine in New York City. "We treat these patients with standard migraine medications."

Solomon is following this course of action.

"My doctor prescribed triptans, which have been somewhat effective in reducing the severity and duration of the migraines," he says. A daily supplement of magnesium and a daily dose of aspirin can also work for some patients, according to Fink.

Lifestyle modification is also a great idea.

"Patients should keep regular sleep hours, getting up and going to bed at the same time every day," Fink continues. "Daily exercise is also recommended."

Solomon suggests tracking migraine triggers and patterns in a journal.

"Try to identify lifestyle changes that help, like managing stress and staying hydrated," Nathan advises. "Seeking support from healthcare professionals and support groups can make a significant difference."

The best news of all: for patients are diligent in following these strategies, they've been proven to work.

"We doctors are very optimistic when it comes to good outcomes for patients with long COVID and migraine," Fink says. "I reassure my patients by telling them, 'You will get better long-term.' "

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