Are Your Migraine Attacks a Symptom of the New Coronavirus?

Migraine is a specific type of headache condition. Its symptoms include severe throbbing or pulsing pain that can be accompanied by sensitivity to lights or sounds as well as nausea and vomiting.

Headache is a potential symptom of COVID-19 and may often feel similar to a migraine attack. While we’re still learning more about COVID-19 and headache, researchers have noticed that a headache due to COVID-19 is often:

• moderate to severe in intensity
• characterized as having a pulsing or pressing pain
• felt on both sides of the head (bilateral)
• worse with physical activity or when moving the head
• difficult to ease with over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• typically occurs early on in the infection but may be associated with worsening illness when it appears later in infection

While COVID-19 headache may feel like a migraine attack, the two types of headache are actually different:

• A migraine attack is a primary headache. It’s thought that changes in nerve signaling or levels of neurotransmitters like serotonin causes it. Genetics and environment may also play a role.
• COVID-19 headache is a secondary headache. This means it’s caused by another underlying disease or condition (in this case, COVID-19).

In fact, people with a history of migraine have reported noticeable differences between COVID-19 headaches and migraine attacks. For example:

• A COVID-19 headache may not occur with other typical migraine symptoms like nausea, vomiting, or sensitivity to lights and sounds.
• A headache that happens with COVID-19 may feel different than an individual’s typical migraine attacks. For example, it may be felt on both sides of the head (bilateral) as opposed to one side (unilateral).
• Headache due to COVID-19 may not respond to medications that are used to treat acute migraine pain.
• Unlike a migraine attack, a COVID-19 headache hasn’t been reported to be preceded by aura, a group of symptoms that can occur before or during a migraine attack.

Researchers are still investigating the mechanism by which the new coronavirus, SARS-CoV-2, causes headaches. Many of the current theories include the involvement of the trigeminal nerve.

The trigeminal nerve is a large cranial nerve that’s important for movement and feeling for parts of your face and head. Activation of trigeminal nerve pathways is also associated with migraine and other types of headache.

It’s thought that SARS-CoV-2 infection could potentially trigger a headache via the trigeminal nerve in several possible ways:

• direct viral infection of trigeminal nerve endings, which can be found in the nasal passages (a site of early infection)
• invasion of vascular (blood vessel) tissues, leading to changes that may stimulate trigeminal nerve endings
• a release of various inflammatory molecules leading to an inflammatory storm secondary to infection

While some headaches due to COVID-19 may be similar to migraine attacks, it’s important to note that a wide spectrum of headaches has been described in association with COVID-19. These can include headaches that are:

• similar to a headache that you’d experience when you have the flu or the common cold
• similar to a tension headache
• headache associated with coughing

According to the Centers for Disease Control and Prevention (CDC), you should continue taking medications for underlying health conditions during the pandemic.

This includes medications for migraine, which are considered safe to continue taking.

Early in the pandemic, there were concerns that some medications used for migraine could increase COVID-19 risk. This was because it was thought that they may increase levels of ACE2 in the body. ACE2 is the protein that SARS-CoV-2 binds to in order to enter a cell.

Overall, research has not supported these concerns:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are often used to treat acute migraine pain. However, there’s currently no specific evidence that NSAIDs like ibuprofen increase COVID-19 risk.
• Blood pressure medications. ACE inhibitors and ARBs are sometimes used to prevent migraine attacks. However, studies in people with high blood pressure found that they didn’t increase the risk of getting COVID-19 or developing serious illness.

Managing migraine during the pandemic

In addition to continuing to take your medications, you can also do the following during the pandemic to help manage your migraine:

• Check your medication supply. The CDC recommends maintaining at least a 30-day supply of prescription and nonprescription medications.
• Maintain a routine. The pandemic has likely disrupted everyone’s daily routine in some way. Try to adapt your regular routine to this “new normal” to help prevent migraine attacks.
• Continue to practice a healthy lifestyle. This includes getting regular exercise, eating a healthy diet, and avoiding your migraine triggers.
• Lower stress. Take steps to lower your stress levels. You can do this through relaxation techniques like yoga and meditation, or even by doing an activity that you enjoy. Also, try to avoid checking the news too often.
• Reach out. Practicing physical distancing can feel isolating. Don’t hesitate to connect with friends and family during this time through a phone call or video chat.
• Talk to your doctor. If you have questions or concerns about migraine or medications, be sure to contact your doctor. Many doctors are offering telehealth visits instead of in-person visits during the pandemic.

Research into COVID-19 and its associated risk factors is ongoing. There’s currently no evidence to suggest that people who have migraine have an increased risk for COVID-19.

The CDC has developed a list of conditions that, based on current research, may put you at increased risk for serious COVID-19 illness. Migraine isn’t currently on this list.

If you have a history of migraine, you may have an increased likelihood of certain kinds of headache symptoms, should you become ill with COVID-19.

One study looked at COVID-19 headache in 112 people with a history of different headache types. It found that people with a history of migraine had an increased likelihood of experiencing a pulsating type of pain compared to people with a history of other headache types.

You’re at risk for getting COVID-19 if you’ve been in close contact with someone with the virus. The CDC defines close contact as being within 6 feet of someone with a SARS-CoV-2 infection for at least 15 minutes.

Additionally, several risk factors for more severe illness due to COVID-19 have been identified by the CDC. These include:

• older age
• cancer
• chronic kidney disease
• chronic obstructive pulmonary disease (COPD)
• heart conditions, including cardiomyopathies, coronary artery disease, and heart failure
• obesity
• sickle cell anemia
• type 2 diabetes
• weakened immune system due to receiving an organ transplant

Several other conditions continue to be evaluated by the CDC as risk factors for serious illness. Some examples include:

• asthma
• high blood pressure
• liver disease

There are some symptoms of COVID-19 that are more commonly reported than headache. These include:

• fever
• cough
• fatigue
• shortness of breath

Other symptoms that can occur at a similar or lower frequency to headache are:

• sore throat
• aches and pains
• chills
• runny or stuffy nose
• digestive symptoms like nausea, vomiting, or diarrhea
• loss of smell or taste

If you think that you have COVID-19, plan to stay at home and limit your contact with others. Contact your doctor to let them know about your symptoms and to receive advice on how to manage them.

When to seek medical care if you think you may have COVID-19

While most cases of COVID-19 are mild, there are some symptoms that are warnings of serious illness. Seek immediate medical care if you experience any of the following:

• difficulty breathing
• chest pain or pressure that’s persistent or long lasting
• a blue color in your lips, face, or nails
• feeling confused or disoriented
• having trouble waking up or staying awake

There are currently no treatments that are approved to specifically treat COVID-19. Instead, treatment is focused on managing symptoms as you recover.

If you have a mild case, you can do the following things at home:

• Consider taking OTC medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve) to help relieve aches and pains.
• Drink plenty of water to avoid dehydration.
• Rest up to help your immune system fight the virus.

In people with more serious disease, treatment is also focused on symptom management and may include:

• oxygen therapy
• antibiotics to manage secondary bacterial pneumonia
• mechanical ventilation

In some cases, doctors may use experimental treatments to help treat people who have been hospitalized with COVID-19. Some examples of these include:

• corticosteroids to help reduce inflammation, such as dexamethasone or prednisone
• antiviral drugs, such as remdesivir
• convalescent plasma transfusions

Most cases of COVID-19 are mild and can be treated by managing your symptoms at home through rest and OTC medications. People with a mild case of COVID-19 may typically begin to feel better in 1 to 2 weeks.

According to the WHO, about 1 in 5 people with COVID-19 become seriously ill, often requiring hospitalization. In these cases, the recovery period may be 6 weeks or longer.

Researchers estimate that about 1 percent of people who develop COVID-19 die from the illness. However, this can vary based on location and the specific population being studied.

COVID-19 can have long-term effects. Some of these include:

• persistent fatigue
• shortness of breath
• damage to the lungs, heart, or kidneys

The exact percentage of people who experience lasting effects of COVID-19 isn’t yet known.

COVID-19 can cause a moderate to severe headache that can be similar to a migraine attack. This headache often occurs on both sides of the head, has a pressing or pulsing pain, and gets worse with physical activity.

People who have migraine may notice that a COVID-19 headache is different from the migraine attack that they typically experience. In these individuals, a COVID-19 headache may not occur with other migraine symptoms and may not respond to some medications.

There’s currently no evidence that having migraine puts you at risk for COVID-19 or developing serious COVID-19 illness. Additionally, you can continue taking your migraine medications during the pandemic.

While most cases of COVID-19 can be treated at home, some cases are more serious. Seek emergency care if you have COVID-19 and have symptoms like trouble breathing, chest pain, or confusion.

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