Have you noticed that your migraine is just weirder after your COVID-19 infection? We have answers for you.

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Recently medical director Dr Thomas Berk, MD FAHS and our friends at Migraine Strong tackled this crucial topic: the impact of COVID-19 on migraine disease. Here are some key takeaways.

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Increased Migraine Risk After COVID:

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Dr. Berk highlighted a concerning trend: "There's been a significant increase in people experiencing new-onset migraine or worsening of their existing migraine after contracting COVID-19." This highlights the potential long-term effects of the virus on the nervous system, and aligns with recent research suggesting a higher risk of migraine attacks following a COVID infection.

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What's the link?

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When considering migraine chronification after a COVID infection, remember that migraine is a condition of neuro-inflammation and that, when your body fights an infection, it's an inflammatory process.

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Since COVID-19 triggers an inflammatory response throughout the body, this response produces inflammatory neurotransmitters in the brain, possibly manifesting as migraine symptoms. "Part of that inflammatory process involves the brain producing som eof the same inflammatory neurotransmitters that manifest with migraine symptoms, either that's pain or non-pain. One thing we know about migraine is that more migraine tends to beget more migraine. So, in general, that's how we've always thought that the increase in frequency happens shortly after infection. That's why it's important to jump on treatment and get ahead of it."‍‍
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What to Do During a COVID Infection

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If you already have chronic migraine, act fast. Contact your primary care provider or see an urgent care provider to determine if you're a fit for any acute COVID treatments, like Paxlovid or Remdesivir (treatment will depend on your age, contraindications, and other comorbidities). Headache specialists or neurologists are not the appropriate provider to determine whether or not you need acute intervention like an anti-viral.

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When you have this appointment (or message your provider), list all of your preventive and acute medications because there may be contraindications with the COVID acute anti-virals. Once you're familiar with the contraindications, you can build an appropriate acute toolkit to last you throughout your COVID infection.

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What to Do After COVID

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If you've developed headaches and other symptoms following a COVID infection, schedule an appointment to see a headache specialist.

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Additionally, you'll likely need additional testing. "We need to reinvestigate things, we need to do imaging, and we probably will want to do blood tests to make sure we aren't missing anything," cautioned Dr Berk.

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There are over 200 headache disorders in the ICHD-3. So your post-COVID headache may or may not be migraine. When it comes to migraine, it's an inconsistent disease. In fact, migraine's most consistent feature is that it fluctuates and changes on an ongoing basis. So if your post-COVID headache pain and symptoms are consistently the same, the headache disorder is probably not migraine. Many other headache disorders are symptomatically consistent. So if your attack features never change, discuss other headache diagnosis possibilities with your specialist.

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Migraine Management After COVID-19:  

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If you've had COVID and have noticed that your past treatment plan no longer is effective, Dr Berk considers adopting a different approach that still is rooted in your personal migraine history. Oftentimes, the patient will need a two-pronged approach that combines preventive treatment with a robust acute toolkit, especially if the person has frequent migraine attacks. If the person has developed chronic or high-frequency chronic migraine, they should discuss having multiple kinds of acute medications that can be alternated so the person doesn't risk medication adaptation headache.

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Additionally, if your migraine has changed, it can be a slightly more refractory kind of migraine, to the extent that you may need more preventive options so that your acute treatments can work effectively. If it feels like your migraine attacks are more refractory, remember that the medications aren't less effective but that you need an extra boost to help your medications do their job again.

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Will This Ever Go Away?

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If you've developed chronic migraine, you'll likely need to shift your definition of improvement. Improvement with episodic migraine is quite different than improvement when you have chronic migraine.

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First, remember that your migraine will be a little more refractory than it was before your COVID infection. Treating your migraine now requires patience and an open-mind. This doesn't mean that you never will return to your previous baseline (deep breaths!), it means that it may take longer than expected to reach that goal.

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• Consult a Specialist: If you're experiencing a change in your migraine patterns after COVID, it's important to see a neurologist or headache specialist. A proper diagnosis and personalized treatment plan are crucial.
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• Outline a Plan: Work with your headache specialist or neurologist to outline a treatment plan and set goals. And when you set these goals, think about what would be the most meaningful change to your life. Would it be a full-time job? Driving your kids to and from school? Exercising again? Set that goal and work toward it.
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• Be Patient: Remember that this is a marathon, not a sprint, and returning to your previous baseline will take patience and time. You likely will need to try different treatments and solutions before you detect any improvement.
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Remember, you're not alone! By staying informed and working with your doctor, you can effectively manage your migraine disease even after a COVID-19 infection. If you need supportive care due to post-COVID neurological complications, we are here to help! Book an appointment today.

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