Headache Associated With COVID-19

Epidemiology, Characteristics, Pathophysiology, and Management

Pedro Augusto Sampaio Rocha-Filho MD, PhD


Headache. 2022;62(6):650-656. 

In This Article


There are no clinical trials that assess the treatment of headache in the acute phase of COVID-19.

The effect of using corticosteroids on COVID-19 headache remains controversial. An Egyptian study assessed 172 hospitalized patients with COVID-19 and headache. As part of the hospital protocol, corticosteroids were used for moderate to severe cases of COVID-19, regardless of headache. No association was observed between using or not using corticosteroids with the frequency or intensity of headache. Fever and dehydration were associated with a more intense headache, drawing attention to the need to treat these conditions.[31] Another Egyptian study included 782 hospitalized patients with COVID-19. Corticosteroids were also used in moderate to severe cases. Eighty percent of patients with headache responded well to analgesics. There were statistically significantly fewer patients who had used corticosteroids in the poor responder group.[20]

A study conducted in a Spanish hospital reported that the most commonly used drugs for headache were acetaminophen (75%) and nonsteroidal anti-inflammatory drugs (NSAIDs), metamizole, triptans, or a combination of these (25%). A total of 26% reported complete pain relief, and 54% reported partial relief.[14] In another Spanish study, 95% of patients needed to use medications for headache, including acetaminophen (93%), ibuprofen (17%), and metamizole (12%).[16]

In a Turkish study, 59% of patients hospitalized for moderate COVID-19 reported an improvement in the headache after 1 g of intravenous paracetamol was administered. Those who did not improve with paracetamol underwent greater occipital nerve blocks using lidocaine, with an improvement in 85% of cases.[26]

A study that included 37 patients with headache that occurred during the acute phase of COVID-19 or that persisted after other symptoms resolved, assessed the use of oral indomethacin (50 mg twice daily for 5 days). Thirty-six patients reported that there was greater than 50% improvement in the headache.[46]

At the beginning of the COVID-19 pandemic, there was concern that the use of NSAIDs, especially ibuprofen, was associated with a worse prognosis of the disease and greater infectivity of SARS-CoV-2. However, this was not confirmed in later research. Thus, these drugs can be used safely.[47] The kidneys are one of the target organs in COVID-19, and it is necessary to monitor kidney function should the use of NSAIDs be necessary.[48,49]

A case series described six patients whose headache improved after sphenopalatine ganglion block. However, it is unclear whether the headache was acute or persistent, or for how long the patients were followed up.[50]