Understanding and managing headaches and pain after COVID-19 using known biological mechanisms

Headache occurs in up to 70% of COVID-19 patients, highlighting its significance as both a clinical challenge and a model for understanding SARS-CoV-2 effects.

• Younger age, female sex, and a prior history of headache disorders are associated with the epidemiology of COVID-19 headache.
• The clinical symptoms of COVID-19 headache are diverse and strongly linked to chemosensory dysfunctions, such as loss of smell.
• Core mechanisms involved in COVID-19 headache include neuroinflammation, trigeminovascular activation, and sex-specific interactions between the immune and endocrine systems.
• Acute headaches may respond well to conventional pain relief, while persistent cases, which are part of Post-Acute Sequelae of COVID-19, require a multidisciplinary management approach.
• Headaches after vaccination tend to be self-limiting, contrasting with those experienced during COVID-19 infection.
• Future research should focus on chronicity, sex-specific mechanisms, and developing personalized treatment strategies.

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