By Thomas Berk, MD, Medical Director of Neura Health

Since the pandemic began, we have been witness to many different neurologic manifestations of SARS-CoV-2. Unfortunately, much of the medical community is still baffled by this condition. As much as we have learned about the acute and long-lasting effects of COVID-19, it’s still very early. The science is evolving as the virus changes, and the societal impact of vaccines must be considered. Patients who have been infected with COVID often complain of brain fog, depression/anxiety, shortness of breath, insomnia, dizziness, and headaches, among many, many other symptoms.

Prevalence of Post-Covid Neurological Conditions

On June 11, 2024, the National Academies of Sciences, Engineering, and Medicine (NASEM), issued a new definition of long COVID, providing a more standardized way to identify and diagnose this condition, which provides more clarity and understanding of how long COVID systemically affects the body. While our understanding of COVID-19's acute and long-term effects has grown significantly, much remains unknown, particularly regarding the long-term neurological consequences. This ongoing research gap is due in part to the virus's continual evolution and the developing impact of widespread vaccination efforts.

One of the most concerning aspects of COVID-19 is the development of post-covid syndrome, also known as "Long Covid." This condition refers to a constellation of symptoms that can persist for weeks or even months after the initial infection, even in individuals who experienced mild or asymptomatic COVID-19. Many of these symptoms are neurological in nature, causing significant distress and impacting daily life.

Post-Covid Syndrome

Colloquially known as “Long Covid,” this set of symptoms can continue even after testing negative for the virus. “Long haulers” are patients with post-Covid syndrome, who experience many neurologic symptoms including:

Brain fog
Depression/anxiety
Shortness of breath
Dizziness
Light-headedness
Insomnia
Headaches
Temperature dysregulation
Sensory changes including tingling
Tremor
Seizures

Prevalence of Post-Covid Symptoms

Determining the exact prevalence of post-covid neurological conditions is challenging due to several factors. Studies vary in their methodology and definitions of "neurological symptoms." However, estimates suggest that a significant portion of COVID-19 patients experience some form of neurological complication. A 2022 Nature Medicine study found an increased risk of long-term neurological disorders in people who had COVID-19, with a hazard ratio of 1.42 (meaning a 42% increased risk) compared to those who were not infected.

Symptoms of Post-Covid Conditions

The new NAESM definition recognizes that various diagnosable conditions, such as postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can coexist with long COVID. Exacerbations of pre-existing neurological conditions, such as migraine, can even be a feature of Long Covid. They can be part of the long COVID picture, not separate issues.

The range of post-covid symptoms is vast and can encompass various bodily systems. Neurological symptoms are frequently reported, and some of the most common include:

Cognitive dysfunction: Often referred to as "brain fog," this can manifest as difficulty concentrating, memory problems, and slowed thinking.
Depression and anxiety: These mood disorders are prevalent among Long Covid sufferers and can significantly impact quality of life.
Headaches: Post-covid headaches can be debilitating and may differ from pre-existing headaches.
Dizziness and lightheadedness: These symptoms can be frightening and disrupt daily activities.
Insomnia and sleep disturbances: Difficulty sleeping is a common complaint among Long Covid patients.
Sensory changes: Tingling, numbness, and altered taste or smell can occur.
Temperature dysregulation: Throws your body's thermostat off-kilter, leading to chills, sweats, and even different body parts feeling extremely hot or cold simultaneously, despite a normal environment.

These are just some of the many symptoms reported by people with Long Covid. The exact cause of these lingering effects remains under investigation.

Treatments for Other Post-Covid Symptoms

While there is currently no cure for Long Covid, various treatment approaches can help manage specific symptoms and conditions, which will improve quality of life. For example, vestibular rehabilitation therapy can help with dizziness, and cognitive rehabilitation can address brain fog. It's important to note that this blog post focuses on headache, migraine, and neurological symptoms, but similar individualized treatment plans are being developed for other Long Covid symptoms.

Prevalence of Post-Covid Headache

The exact percentage of people infected with COVID who experience headaches varies by each study. The American Migraine Foundation says that 47% of patients have gone on to develop a headache following a Covid infection, with about 8% of them experiencing headaches that persist even 6 months after the infection.

Symptoms of Post-Covid Headache

There are differences from patient to patient, but post-Covid headache tends to present similarly to your prior headache disorder (if you have one). For instance, if you have a migraine diagnosis, it will resemble a migraine attack because it worsens with exertion. The throbbing pain might be unilateral or switch from one side to another, and, like migraine, it often has sensitivity to light and sound, and sometimes to smell or touch. Nausea is also common.

Studies show that migraine patients are more likely to develop post-Covid headache than people without a history of migraine. Migraine patients may also see an increase in migraine attacks after having Covid.

Treatments for Post-Covid Headache

Although we are a few years into this pandemic, it is still challenging to treat many post-Covid headache symptoms. Data is still emerging and there is significant variability from patient to patient. For this reason, it is also difficult to predict the severity or duration of post-Covid headache. Some patients with a history of migraine tell us that their post-Covid headache is similar to their migraine but doesn’t necessarily respond to their typical migraine medications. Other patients report their COVID-related headaches are different—either they last longer or are more severe. This is why individualized treatment is necessary.

Some other post-Covid symptoms can improve with a short steroid course, and many headache symptoms can improve with this as well. This is often considered the first-line treatment for post-Covid headache, but it can become somewhat more complicated if this initial course is not entirely effective.

It can often be difficult to distinguish features of headache that you might be experiencing after Covid. The consensus among specialists that treat post-infectious headaches is to consider using treatments that are effective for the subtypes of headache the patient appears to present with. For example, if there are more features of migraine (throbbing, light and sound sensitivity, and nausea) we would consider both preventive and acute medications for migraine, and if there are features of tension-type headache or another unique headache type, we would treat those specific symptoms.

Who Should Treat Your Post-Covid Symptoms

Not all doctors are as familiar with the subtleties of these diagnoses, and if your headaches are difficult to treat, or have not responded to initial treatments, you should consider seeking out the opinion of a headache specialist to reconsider your treatment options.

Because post-Covid neurological symptoms vary in nature, a team approach may be necessary to ensure you get the most comprehensive care possible. This may mean that you have an epilepsy specialist treating your post-Covid NES, a headache specialist treating your daily headache, and a neurologist treating your tremor and dizziness. All are familiar with the latest research and treatment options and would collaborate to ensure you receive the care you deserve. If you don’t have a specialist for your Long Covid symptoms, you can meet with one via video conference using Neura Health.