Toward a Better Understanding of Persistent Headache After Mild COVID-19

Three Migraine-like Yet Distinct Scenarios

Edoardo Caronna MD; Alicia Alpuente MD; Marta Torres-Ferrus MD, PhD; Patricia Pozo-Rosich MD, PhD


Headache. 2021;61(8):1277-1280. 

In This Article

Abstract and Introduction


One year after the outbreak of coronavirus disease 2019 (COVID-19), referrals for persistent headache, often defined as "post-COVID headache," have become increasingly common in outpatient headache clinics. However, it is important to take into consideration that this term may include a spectrum of clinically different headache types. We describe three cases of migraine-like headaches in individuals with a history of mild COVID-19 infection to demonstrate some of the different phenotypes of persistent headaches seen. These cases highlight the importance of a careful evaluation when assessing the complexities of "post-COVID headache" as well as the need to further investigate the different, underlying, pathophysiological mechanisms.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus, responsible for coronavirus disease 2019 (COVID-19),[1] that emerged in China at the end of 2019 causing the current global pandemic.[2] During the acute phase of infection,[3] COVID-19 can trigger a headache that is phenotypically similar to migraine or tension-type headache,[3,4] among other neurological symptoms.[5]

Some patients do not fully recover after the acute phase and experience persistent symptoms and/or delayed or long-term complications of COVID-19, generally referred to as "post-COVID syndrome."[6] These symptoms may include memory impairment, insomnia, fatigue, dizziness, etc.[7,8] Headache is also a post-COVID symptom[9] in some patients and consultations for persistent headache attributed to COVID-19, often referred to as "post-COVID headache," are presumably being seen more often in clinical practice.

Although data on persistent headache attributed to COVID-19 are still lacking, clinical observation by neurologists during their daily practice appears to indicate the presence of many different headache types. This would imply that the term "post-COVID headache" may be too broad to describe the complex spectrum seen. Different types of headaches may be a result of different pathophysiological mechanisms, even if they display similar characteristics, such as migraine-like features. Consequently, they may have different prognoses and responses to treatment.

Here, we describe the cases of three different patients, evaluated in our headache clinic, with "post-COVID headache." We focus on patients with a history of mild COVID-19 infection and migraine-like features to stress the existence of a complex scenario even within a group of patients with similar characteristics. We discuss our main findings and their implications below.