Dr. Huma Sheikh is a Board-Certified and Harvard-Trained Neurologist specializing in Headaches and practicing in New York City. She gives us an important account of the current findings of persistent headaches in connection with COVID-19 infection. Many children and adults in the United States suffer each year from severe headaches or migraines. This estimate has been close to 10% or more of the total population in some studies. Headaches can be a significant health concern for many patients, affecting aspects of their health, as well as their personal and social lives. Doctors have noticed a higher incidence of headache among patients that have been infected with COVID-19. We interview Dr. Huma Sheikh, Expert Neurologist and Headache Specialist, about this subject.
myDoqter: Dr. Sheikh, we are seeing a wide array of symptoms with COVID-19 infections and we are learning more and more every day. We are hearing about various neurologic symptoms of coronavirus infection. Can you tell us, does COVID give you neurological symptoms and, if so, what kind?
Dr. Sheikh: As the pandemic continues, we are starting to see all the ways that the coronavirus can present. There are now a number of different reports for all the different possible neurological symptoms that it can cause. The first reports were that it could cause a loss of smell, known as anosmia, as well as loss of taste. The other possible neurological symptoms can include- headaches, dizziness, strokes, weakness, decreased alertness, muscle pain and difficulty concentrating.
myDoqter: How common are headaches with Coronavirus (SARS-COV-2)?
Dr. Sheikh: New reports show that headaches may be common with COVID-19 and could predict the course of the disease in patients. One study of 100 patients showed that headaches can be one of the first signs, starting even before any other symptoms. The headaches can have symptoms similar to tension-type or migraine headaches. Other reports show that it can occur in about 14% percent of patients. Those that had headaches as a part of their symptoms tended to have shorter periods of symptoms. However, there were patients where headaches continued even after all other symptoms were gone. This study shows that headaches in COVID can vary greatly but are a common symptom of the virus.
myDoqter: So, we are learning COVID-19 infection can present with headaches and induce persistent new-onset headaches. Can COVID worsen headaches in patients with underlying headache disorders like migraine?
Dr. Sheikh: Migraine is a neurological disease that lowers the threshold or the risk of getting a headache, especially with certain environmental triggers. Any stress on the body can be a trigger for migraine, and many patients with migraine can have their migraine worsen when they have a viral illness. In addition to worsening of headaches when someone is infected, the stress of all the recent world affairs is also a prominent trigger for worsening of headaches in many people. Neurologists are starting to see a worsening of migraine for many people who were previously stable. Some of this is due to the fact that they have not been able to receive their usual medications, including injections, given that many offices were closed for some time. However, recent increased stress given the pandemic is also a recent major cause. Stress can cause shifts in sleeping patterns, which also is an important trigger for people with migraine. Shifting schedules, home-schooling, financial worries can all lead to stress that can make migraines more frequent or severe in recent times.
myDoqter: Dr. Sheikh, can you tell us the mechanism of how a viral infection causes headaches?
Dr. Sheikh: Viral or bacterial particles are able to travel into the brain and in some cases cause inflammation in the blood vessels of the brain. This can be one mechanism that can lead to headaches. They can also travel through the nose and reach the nerve endings that are present there. In some cases, a sudden severe headache can be a sign of a more dangerous brain infection, sometimes known as meningitis. Some infections can also cause swelling in the brain, which can also cause headaches. This has not been a particular concern with COVID but may be a possible component in other diseases. In some reports, COVID can lead to stroke, and for some people a stroke can present with headache as well.
myDoqter: Are there risk factors for more serious infections and headache with COVID infection. Is a history migraines a risk factor for COVID, and are people who experience migraine more at risk of COVID-19?
Dr. Sheikh: There are no studies showing that having a history of migraine will make someone more at risk of becoming infected with COVID or develop more severe symptoms if one does become infected. There has not been a history of increased risk of infection with underlying risk of migraine. The groups currently that have been identified to have severe complications from COVID-19 include those patients who are age 65 years or older, have underlying heart conditions, diabetes and/or severe obesity, as well any condition that may cause a weak immune system, such as patients undergoing chemotherapy for cancer.
myDoqter: Headaches are so common that many can be treated with over-the- counter medications. What are the treatments for headaches as a symptom of COVID? Are there any special considerations?
Dr. Sheikh: For now, there are no specific treatments for headaches that are a result of the virus. They are similar to the other treatments that are used for headaches caused by a viral infection. This includes treating with anti-inflammatory medications. There were initial reports that ibuprofen may cause worsening of COVID symptoms but that has not since panned out.
myDoqter: How about migraines? What are the treatments for migraines that become worse during this time?
Dr. Sheikh: There are a number of available treatments for migraine. There has also been an increase in the use of tele-health services, allowing for more patients to be able to gain access to doctors and especially headache specialists to help with their diagnosis and treatment. If migraines worsen during this time, it is important to identify the triggers that are worsening the migraine. Some of the areas to focus on include: sleep, exercise, and reducing stress levels. Methods to decreased stress are particularly important during this time. There are a number of different methods to help with this, including cognitive behavioral therapy and relaxation techniques. Yoga and mindfulness are also two important methods that can overall decreased stress levels and improve migraine.
myDoqter: Thank you for sharing your insights and expertise on headaches and COVID-19. Are there good resources for our readers who may want to do further research and/or find a physician to care for them?
Dr. Sheikh: There are a number of different resources that can assist people in finding a physician to help them with migraines and headaches during this time. The American Headache Society as well as the American Migraine Foundation can provide this guidance, as well as valuable articles that are also helpful in the management of headaches.
Our readers may also reach out directly to Dr. Sheikh at her website www.HeadachesNYC.com for questions and concerns, and to inquire about Telehealth consultations.