Long COVID headache (treatment options)

Source: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01450-8

Pharmacological Treatment for Long COVID Headache Phenotypes

Tension-Type Headache (TTH)-like Phenotype

• Acute Treatment:

  • Simple Analgesics: Paracetamol.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Examples include ibuprofen, naproxen.
  • Combination Preparations: Including caffeine.

• Prophylactic Treatment:

  • First-Line: Amitriptyline (tricyclic antidepressant).
  • Second-Line: Venlafaxine or mirtazapine if no therapeutic effect with amitriptyline.
  • Additional Option: Glucocorticoids for reducing headache frequency and intensity (Prednisone, Dexamethasone and Betamethasone).

Migraine Headache-like Phenotype

• Acute Treatment:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Examples include ibuprofen, naproxen.
  • Triptans: Specific mention of their varied efficacy based on the patient's medical history.
  • Indomethacin (50 mg, BID): Particularly for cases non-responsive to NSAIDs and triptans, with 95% of patients reporting significant headache relief from the third day of treatment. Source

• Prophylactic Treatment:
  - Antidepressants and Botox: Amitriptyline (25 mg QD) in combination with BTX (195U) has shown improvement in sleep quality and reduction in headache frequency.

  • Greater Occipital Nerve Block: Suggested for specific cases as short-term preventative treatment.
    

General Considerations

• Patient Evaluation: Important to consider other post-COVID-19 symptoms and cardiovascular risk factors.
• Caution with Vascular-Effect Drugs: Such as triptans in patients with cardiovascular disorders.
• CGRP Consideration: Recognizing its role in cardiovascular health and pulmonary hypertension.

Need for Further Research

• Longitudinal Studies: To evaluate the long-term efficacy and safety of these treatments in long COVID headache.
• Therapeutic Profiles: Need for research on treatments based on individual medical history, post-COVID-19 symptoms, and response to initial treatments.

Possible Headache Types

1. Tension-Type Headache (TTH):

   • This is the most common type of headache and often described as a band-like pressure or tightness around the head, which could align with the feeling of pressure on the forehead and top of the head.
   • The sensation of "cotton or glue" inside the skull might be related to the dull, aching, and persistent nature of TTH.

2. Sinus Headache:

   • If the pressure is primarily around the forehead, it could be associated with sinus issues. Sinus headaches occur when the sinus passages behind your eyes, nose, cheeks, and forehead are congested.
   • These headaches are often accompanied by other sinus symptoms, such as a runny nose, fever, and facial swelling.

3. Cervicogenic Headache:

   • This type of headache is caused by issues in the cervical spine and can manifest as pain in the head, particularly at the top of the head or forehead.
   • It's often accompanied by neck pain and stiffness.

Other Considerations

• Migraine: Some people with migraines describe a sensation of pressure, though migraines are typically characterized by throbbing or pulsating pain.

• Medication Overuse Headache: This can develop from frequent use of headache medication. It’s typically described as a dull, constant headache with pressure.

Important Steps for Diagnosis and Management

1. Medical Consultation: It's crucial to consult with a healthcare provider for an accurate diagnosis. They may conduct a physical examination, take a detailed medical history, and ask about the headache's pattern, intensity, and associated symptoms.

2. Headache Diary: Keeping a diary of headaches, including their frequency, duration, and description of the pain, can be very helpful in diagnosing the type of headache.

3. Consideration of Other Symptoms: Note if there are other accompanying symptoms like visual disturbances, nausea, sensitivity to light or sound, nasal congestion, or neck pain.

4. Lifestyle and Environmental Factors: Factors such as stress, sleep patterns, diet, and posture can also be relevant in understanding and managing the headache.