*This article discusses post COVID brain fog and offers insights into possible causes with suggestions for managing this symptom.*

Updated February 14, 2024

Brain fog, a term used to describe significant, persistent cognitive deficits, with consistent impairment of executive functioning and working memory is a common issue for COVID-19 long haulers. Many describe its symptoms similar to those of dementia, memory loss, ADHD, inability to focus, confusion, indecisiveness, forgetfulness, inability to concentrate, or inability to understand what is being said or read.

Long-haulers may experience a lack of mental clarity, poor focus and concentration, memory problems, difficulty with multi-tasking, and more. Brain fog can be debilitating, but there currently are no treatment options that are approved for the condition.

The top 5 symptoms reported by covidCAREgroup followers in a November 2022 poll include:

Fatigue
Brain fog
Depression
Anxiety
Insomnia
Members report gradual improvement in brain fog as they recover.

How does COVID-19 cause this?

COVID-19 can damage the brain in multiple ways, such as encephalitis, strokes, and lack of oxygen to the brain. But other effects may be more subtle, such as persistent brain fog. In addition to direct effects on the brain, COVID-19 can also have long-term effects on other organ systems.

COVID triggers an immune response that releases of cytokines, the chemicals that normally fight infection and keep you healthy. But COVID interferes with the cytokine control mechanism, so it doesn’t know when to turn off, leading to cytokine storm. In turn, the cytokine storm leads to autonomic dysfunction, when the immune system attacks health organs. This is called dysautonomia. Another issue that develops is mast cell activation syndrome (MCAS) when the body starts to over produce histamines that cause inflammation of the brain, nervous system, organs and tissues. This is called multiorgan inflammation syndrome (MIS). MIS-C refers to children, MIS-A refers to adults.

Histamines are chemicals that occurs naturally in the body and some foods. They normally regulate the body’s response to foreign substances and injury, and are involved in things like allergies, stress reactions, and inflammation in the human body.

**Mast Cell Actvation Syndrome**

Leads to the histamine cascade that causes widespread inflammation of the brain, nervous system, organs and tissues.

Inflammation is the root cause of the top long COVID symptoms as of the brain and/or cranial nerves.

The inflammatory processes appears to occur more severely in brainstem and cerebellum resulting in inflammation and hypo metabolism in these regions. Brainstem inflammatory lesions are the most common damage, which could partly explain the hypometabolic areas.

Don’t despair.

Members report that brain fog subsides once the MCAS related histamines and inflammation are controlled. Speak with your doctor about antihistamines, SSRI and SNRI medications. Consider healthy lifestyle changes that include clean eating habits, low histamine and/or low sugar diet, avoiding foods and drinks with preservatives and chemicals, and avoiding alcohol.

Members of the covidCAREgroup report faster recovery with self-care strategies.

Taking control of your health.

The most important thing to do is to see your doctor to discuss the lingering neurologic symptoms you are experiencing, including brain fog, depression, anxiety, insomnia, fatigue, weakness, numbness, tingling, loss of smell or taste.

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Medication protocols for long COVID and brain fog.

Talk to your doctor about the top 4 concerns: Histamines, Inflammation, Depression, and Blood Clotting

The antihistamine protocol: Seasonal allergy medicines like Allegra or Zyrtec (H1 blockers) and antacids like famotidine or Pepcid (H2 blockers) to counter the histamine cascade.
The anti-inflammatory protocol: Such as steroids in severe cases, or NSAIDs like ibuprofen or other prescription medications to reduce inflammation, pain, and the risk of damage to nerves and organs.
The antidepressant protocol: SSRI and SNRI medications to reduce depression, anxiety or fatigue.
The anticoagulant protocol: Aspirin, baby aspirin or prescription medications to prevent micro-clotting or deep vein thromboses (DVT) that can cause neural damage, organ damage, or stroke by blocking the flow of blood to vital organs.

Potential brain fog treatment announced by Yale in December 2022.

Yale School of Medicine published an article in December 2022 about Guanfacine, a medication that has been used off-label for traumatic brain injury (TBI) and PTSD. Now, providers who have been treating long COVID patients with a combination of guanfacine and N-acetylcysteine (NAC) combined therapy report successful in relieving brain fog for their small sample of patients. And while clinical trials will be needed to establish these drugs as a bona fide treatment for neuro-COVID complications, they say patients can obtain them now if their doctors wish to prescribe them.

There are additional proactive actions you can take to support your own health.

You can ask your doctor to check your bloodwork including complete blood count (CBC), electrolytes, ferritin, a full iron panel, a full thyroid panel including reverse T3 and reverse T4, metabolic profile, cholesterol, C-reactive protein (CRP), ANA, rheumatoid factor, D-dimer, cytokine inflammatory markers interleukin-6 and interleukin-1b, along with kidney function tests.

Western medicine doctors are experts in medications, diagnostic testing, and surgery. It’s important to take a collaborative approach in which you advocate for yourself, ask questions, and bring your ideas based on scholarly research you have found to the MD. Keep in mind, you cannot expect them to have expertise in areas like herbal and homeopathic remedies. Think of it like this - you wouldn’t ask your doctor to fix your car or your mechanic to perform surgery on you. That is not their specialty.

If your MD doesn’t have answers to your questions, it can be a good idea to look at complimentary health approaches such as Functional Medicine, Chinese Medicine, acupuncture, chiropractic, massage therapy. If you want to know about nutraceuticals (natural remedies, herbs and supplements) talk to a Chinese medicine doctor, naturopath or nutritionist.

This is a video interview with a neuropsychologist and a neurosurgeon on post COVID brain fog with a detailed explanation of what it is and done practiced tips on coping with it: Experts share tips to beat COVID ‘Brain Fog’ - Neurosurgeon Dr. Ajmal Zemmar and Psychologist Dr. Sabina Brennan share ways to improve your brain health if you're experiencing COVID 'brain fog.'

Things you can do to help yourself

Nutrition: Try to eat protein and vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein , vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that forced air into your lungs when it senses an apneic episode.
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

Long COVID Solutions

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