Covid-19 or migraine? Here’s how to tell and what to do about it

Does it seem that your migraines are more frequent or worse and more difficult to bear since the pandemic began? That’s not just in your head. Doctors say they are now seeing many more complaints from migraine sufferers — often called “migrainers” — and for good reason.

“The current setting we’re in is certainly quite triggering for people who have migraines. People are worried and they’re getting more migraine headaches,” said Dr. Rachel Colman, director of the Low-Pressure Headache Program at the Icahn School of Medicine at Mount Sinai in New York.

In addition, “many of us have our work-home boundaries blurred right now,” said Dr. Merle Diamond, president and managing director of Chicago’s Diamond Headache Clinic.

“We’re working from home, and oftentimes that makes it harder to have an on-switch and an off-switch,” she said. The change in work can be triggering because “migrainers have very sensitized nervous systems that don’t like change.”

Nor are we getting up and moving, stretching, hydrating or sleeping as we should, which can all be significant triggers, Diamond said. She’s the daughter of Dr. Seymour Diamond, who was renowned for shattering common medical assumptions that migraines were psychosomatic, a sign of depression or just an excuse to avoid chores or work.

“Lack of activity makes migraine worse. Change of schedule makes migraine worse. Sleep has been impacted, which always makes migraine worse. And if you get dehydrated, that certainly doesn’t help,” Diamond said.

Is my headache Covid-19?

Of course, in today’s reality, the first thing that pops into any headache sufferer’s head is: Do I have Covid-19?

Longtime “migrainers” may know the difference, but what if you’re a newbie to the world of head pain? From what is known right now, Diamond said, a headache brought on by Covid-19 presents much differently than a migraine.

“You may have fever, you may have persistent coughing and all of those things can predict a headache,” said Diamond, who is a National Headache Foundation board member.

“However, the headache of Covid-19 is described as a really tight, sort of squeezing sensation, and typically worsens with coughing and fever,” she said.

That sensation happens as our immune system rallys in response to the virus, releasing chemicals called cytokines. Cytokines produce inflammation, which is perceived as pain by the cerebral cortex of the brain.

But a migraine presents much differently, Diamond said, with a throbbing pain that is moderate to severe, and can be accompanied with a sensitivity to light and noise and vomiting.

“The best way to describe a migraine is that it is a sick headache,” Diamond said. “Patients describe it as their brain is too big for their skull.

“Then there’s the migraine hangover. For a lot of patients the pain part of their headache might last eight hours, 12 hours, 14 hours, but after the headache is gone, they have cognitive clouding,” Diamond added.

“They’re lethargic, they’re irritable, they may still continue to have light sensitivity or nausea. The whole process for some migraines can take several days,” she said.

While migraine, tension and cluster headaches are the most common forms, there are hundreds of different subtypes of headaches.

Categories include abdominal, hormonal, caffeine, hypertension, post-traumatic and rebound headaches; allergy, sinus, medication, cough, sex or exercise-induced headaches; as well as headaches defined by symptoms, such as stabbing, thunderclap, ice-pick or exploding head syndrome.

Two severe and dangerous types of headaches are caused by meningitis, where the membranes that cover the brain and spinal cord become swollen or inflamed, and encephalitis, an inflammation of the brain that is caused by viral infection, with neck stiffness and fever.

In Covid-19 cases, the most severe and dangerous headaches seem to be in people who are extremely sick with Covid-19, said Colman, who is a member of the National Headache Foundation Health Care Professionals Leadership Council.

“There’s been some really bad headache disorders with Covid-19,” Colman said. “it’s too early to know for sure, but it does seem like the very ill patients that have very sick lungs and are really struggling in ICU tend to be the ones that are getting the more serious complex neurological complications.”

What to do?

Anyone who is suffering from constant or debilitating headaches or migraines should reach out to a headache specialist for help, experts say. Most are seeing patients via telemedicine, and will work with you to get to the root of the problem.

“I’m trying to troubleshoot some of the issues that are happening during isolation,” Colman said. “Is it the fact that they’re not sleeping, they’re not leaving work at work, they’re not exercising anymore?

“Or is it the fact that they’re very stressed out with worry about financial and personal and family obligations? So trying to kind of find the root cause for why the worsening is to try and work on it,” she said.

There are also preventative things you can do to keep headaches at bay.

“Make sure you have good hydration at the place that you’re sitting and drink a certain amount every hour,” Diamond said. “It’s also important to get up, breathe and stretch at least once an hour.”

Meditation and relaxation exercises are extremely helpful, as is biofeedback, she suggested.

“I think that’s really helpful and it doesn’t take a lot of time. You can do it in five to 10 minutes and it just kinda resets, which is what we want to do,” Diamond said. “Then making sure you’re not skipping meals, and that you’re not overworking. You have to have an off to your day if you can.”