Navigating the Onset of Migraine After COVID-19 Recovery

We continue to live in an uncertain world regarding the lasting effects of COVID-19 on the human body (we know, we know… stating the obvious here). What symptoms linger after being infected? Does a person with a chronic condition, such as migraine, experience heightened attacks post-infection? Or, on the flip side, what new symptoms can crop up for the first time? Is it even possible to “fully recover”?

Understanding Migraine in the Context of COVID-19

Migraine is a neurological condition that is often characterized by intense, throbbing headaches — though not everyone experiences headache symptoms — and is often accompanied by symptoms like nausea, brain fog, and sensitivity to light and/or sound. The relationship between viral infections, including cases of COVID-19, and migraine lies in their impact on the body’s physiological processes (aka “normal” bodily functions). Viral infections can disrupt the delicate balance of neurotransmitters and blood flow in the brain, potentially triggering or exacerbating migraine attacks.

The Physiology of Migraine

Migraine attacks arise from complex neurovascular interactions in the brain. These involve fluctuations in blood flow, activation of pain pathways, and the release of specific neurotransmitters.

During a migraine, there’s a temporary constriction followed by rapid dilation of cranial blood vessels. This alters oxygen and nutrient supply, contributing to the disease’s trademark throbbing pain. Simultaneously, pain pathways in the brain become highly active, intensifying the perception of pain. This involves specific regions like the trigeminal nerve pathway. (Nerve blocks, anyone?)

Neurotransmitters, such as serotonin, also play a role. The up-and-down fluctuations in serotonin levels influence migraine onset, and low levels can increase susceptibility to attacks.

COVID-19’s Impact on the Body

COVID-19 exerts a wide-ranging impact on various bodily systems, potentially contributing to the development or exacerbation of migraine. Inflammatory responses, vascular changes, and neurological alterations following the infection may all play a role in migraine occurrences. Recognizing these potential connections is essential for tailoring effective management strategies, though it can vary from person to person.

Reports of Migraine After COVID-19 Recovery

Recent studies have indicated a notable increase in reports of migraine following COVID-19 recovery. The viral infection profoundly affects various bodily systems as well.

Inflammatory responses, crucial for combating infections, are activated by COVID-19. These can lead to systemic inflammation, affecting diverse tissues and organs. This state of inflammation may influence the occurrence of a migraine or worsen an existing one.

Vascular changes are also significant in COVID-19’s wake. The virus can disrupt blood vessel function, potentially disturbing the equilibrium of blood flow in the brain. These shifts in vascular dynamics can directly affect the development of a migraine, as alterations in blood flow are a pivotal aspect of migraine physiology.

Furthermore, COVID-19 can induce neurological shifts, including effects on the central nervous system. This system plays a vital role in regulating pain perception and sensory processing. Disruptions in these neurological processes can heighten an individual’s vulnerability to migraine or increase the severity of existing episodes.

Possible Triggers of Post-COVID Migraine

In the aftermath of recovering from COVID-19, several elements can serve as potential triggers for migraine (they are also common migraine triggers in general). They include:

• Stress: Elevated stress levels can potentially trigger migraine attacks in individuals who have recently recovered from COVID-19. Implementing stress-reducing techniques like relaxation exercises and mindfulness can help.
• Sleep disturbances: Irregular sleep patterns, insomnia, or inadequate rest can disrupt the body’s circadian rhythm, making individuals more susceptible to migraine. Establishing and maintaining healthy sleep hygiene practices — like sleeping and waking up at the same time every day — can help reduce the likelihood of attacks.
• Dietary choices: Certain foods and beverages containing artificial additives, caffeine, or histamines have been identified as potential migraine triggers. If applicable, recognizing and avoiding these substances may boost a patient’s personalized migraine management plan.
• Hormonal fluctuations: Especially in people assigned female at birth, hormonal events like menstruation, pregnancy, or menopause can trigger migraine episodes or alter their frequency and severity.

Differentiating Post-COVID Migraine from Other Headaches

Post-COVID migraine attacks present with distinct features that set them apart from other types of headaches. Understanding the specific characteristics and patterns between the headache diseases — of which there are over 100! — is essential for targeted treatment.

Characteristic Symptoms of Post-COVID Migraine

Post-COVID migraine often manifests with distinct symptoms. These may include:

• Pulsating or throbbing head pain: This is a hallmark feature of post-COVID migraine. The pain is often described as intense and rhythmic, with a pulsating or throbbing sensation.
• Unilateral pain: Post-COVID migraine often present with pain concentrated on one side of the head. This unilateral aspect can aid in distinguishing them from other types of headaches, which may not exhibit this specific pattern.
• Visual disturbances and auras: Visual disturbances, such as auras or alterations in visual perception, are frequently reported by individuals experiencing post-COVID migraine. These visual symptoms can range from flickering lights to temporary vision loss. While auras can occur in typical migraine as well, their presence in the context of post-COVID migraine underscores the distinct nature of this condition.
• Heightened sensitivity to light and sound: Photophobia (sensitivity to light) and phonophobia (sensitivity to sound) are pronounced features of post-COVID migraine. Individuals may find that even mild levels of light or sound exacerbate their symptoms.
• The timeline of COVID-19 infection: Perhaps the most crucial distinguishing factor is the connection between the onset of migraine and recovery from COVID-19. Which health experience came first?

When to Seek Medical Advice

Knowing when to consult a primary care provider or neurologist about the onset of headaches following COVID-19 recovery is paramount, as persistent, severe, or atypical migraine symptoms warrant an assessment to rule out underlying complications. Here are some to look out for:

• Persistent or prolonged symptoms: If migraine symptoms persist for an extended period, it is advisable to seek professional advice. This includes headaches that last for an unusually long duration or occur frequently over an extended period of time.
• Severe or intense pain: Severe migraine attacks can significantly impact an individual’s quality of life. If the pain is particularly intense, seeking medical attention is essential.
• Atypical migraine presentation: Take note if your symptoms deviate from your typical experience, including any new or unusual symptoms that may indicate underlying health issues.
• Presence of alarming symptoms: Seek prompt medical advice if neurological symptoms like difficulty speaking, confusion, loss of consciousness, or other signs of potential complications arise.
• Impact on daily functioning: Pay attention to whether migraine significantly impedes daily activities, such as work, social interactions, or personal hygiene.
• Pre-existing health conditions: Individuals with pre-existing medical conditions or a history of neurological disorders should be particularly vigilant about seeking medical advice, as they may have unique considerations that necessitate specialized care.
• Changes in migraine patterns: Discuss any notable changes in the frequency, duration, or intensity of migraine attacks with a health care provider. This can help identify potential triggers or underlying factors that may require attention.
• Safety and well-being: Prioritizing one’s safety and overall well-being is paramount. If migraine impacts your ability to drive, operate machinery, or perform other tasks that require focus and attention, seeking medical advice ensures both personal safety and the safety of others.

Managing Migraine After COVID-19

Just like with any chronic health condition, effectively managing episodic migraine or chronic migraine in the post-COVID phase involves a multi-faceted approach.

Lifestyle Adjustments and Home Remedies

Lifestyle changes like regular exercise, balanced nutrition, and stress reduction techniques can contribute to migraine management. Additionally, simple home remedies like cold compresses (we love ice hats!), relaxation techniques, and increased hydration strategies may relieve and complement medical interventions.

Medical Treatments and Interventions

Health care providers may recommend a range of medical interventions based on the severity and frequency of your migraine attacks. A combination of the following options may be used to create a tailored treatment plan:

• Prescribed medications: Health care providers may prescribe medications to help alleviate migraine symptoms. These can range from pain relievers for mild migraine to more specialized medications for moderate to severe cases. Triptans, for instance, are a class of drugs specifically designed to target migraine attacks by constricting blood vessels and blocking pain pathways.
• Preventive medications: In cases of frequent or severe migraine, health care providers may recommend preventative medications. These medications are taken regularly to reduce the frequency and severity of migraine attacks. They can include beta-blockers, anticonvulsants, and certain antidepressants.
• Botulinum toxin injections: Botulinum toxin injections, commonly known as Botox injections, have shown efficacy in preventing chronic migraine. These injections are administered every few months and work by relaxing the muscles and reducing nerve signals that trigger attacks.
• CGRP monoclonal antibodies: CGRP (calcitonin gene-related peptide) is a protein involved in the development of migraine. Monoclonal antibodies that target CGRP or its receptors have emerged as a promising treatment option for migraine prevention. These medications are usually administered via injection and can be effective for individuals with frequent and debilitating discomfort.
• Nerve blocks: Nerve blocks involve injecting anesthetic or other therapeutic agents around specific nerves associated with migraine. This procedure can provide temporary relief and is particularly useful for individuals with acute, severe migraine.
• Neuromodulation devices: Devices that use neuromodulation techniques, such as transcranial magnetic stimulation (TMS) or non-invasive vagus nerve stimulation (nVNS), have shown promise in migraine management. These devices alter the electrical activity in the brain, potentially reducing the frequency and severity of migraine.
• Biofeedback and Cognitive Behavioral Therapy (CBT): These non-pharmacological approaches focus on training individuals to control physiological functions and modify behavior patterns associated with migraine. Biofeedback involves learning to monitor and regulate physiological responses, while CBT addresses psychological factors that may contribute to attacks.
• Acupuncture and chiropractic care: Some individuals find relief from migraine through alternative therapies like acupuncture or chiropractic care. These practices restore balance and alleviate tension in the body, potentially reducing migraine frequency and severity.

Long-Term Outlook for Post-COVID Migraine Patients

Gaining insight into the long-term prognosis for people living with migraine after recovering from COVID-19 is essential for making informed decisions about patient care, as well as optimizing long-term outcomes. As medical research advances, ongoing studies are dedicated to unraveling the complexities of post-viral migraine. Furthermore, the awareness and recognition of post-COVID migraine within the medical community is continuously growing.

Here’s to a better quality of life, migraine friends.