Many of us have been keeping an eye out for any possible coronavirus symptoms, but is headache one of them? In normal circumstances, a headache might be an annoyance chalked up to stress or bad posture (hello, hunching over the keyboard). But these days, many of us are wondering: Is headache one of the coronavirus symptoms? And if so, is it only a concern if you have the more obvious symptoms like fever and dry cough, or is a headache on its own enough to raise alarm bells? The answer, as with most things with this virus, is more nuanced than a simple “yes” or “no.” Remember: Headaches are unfortunately common, including very painful ones. The most common types of headaches people experience are tension headaches, according to Alexander Mauskop, M.D., professor of clinical neurology at SUNY Downstate Medical Center. Tension headaches are rarely severe, so people don’t usually end up at the doctor for them. Tension headaches are caused by muscle contractions in the neck or scalp, and they can be brought on by anything from stress to dehydration to eye strain. If you get frequent headaches, it might be tension headaches. And then, of course, there are migraines. Migraines are more than just a headache—they’re actually a chronic neurological disease. Severe head pain is often a main symptom, but migraines can also cause nausea, sensitivity to light and sound, blurred vision, and an aura (a visual disturbance). As SELF previously reported, migraines tend to require more intense treatment than tension headaches. Sinus headaches are another common headache. Most true sinus headaches are caused by sinus infection, so it typically occurs with other sinus-related symptoms. “If you have yellow or green discharge, that’s usually a sinus infection and you can get a sinus headache,” Dr. Mauskop says. Antibiotics can clear up bacterial sinus infections; viral sinus infections usually resolve themselves in a few days. But sinus headaches are often migraines in disguise, Dr. Mauskop explains, so if they don’t clear up or if you don’t have sinus symptoms, check back in with a doctor. There are also cluster headaches, which are much rarer than migraines, but are “the worst imaginable pain,” Dr. Mauskop says. “Some people call them ‘suicide headaches.’” They’ll often wake you in the middle of the night with focused pain around one eye or one side of your head, according to the Mayo Clinic, and they have a cyclical pattern that lasts for weeks to months. What’s causing your head pain will likely depend on the type of headache you’re experiencing, but many of them include a common trigger: stress. Not unlike that caused by a global pandemic. Victoria Fang, M.D., associate medical director of the UW Medicine Neighborhood Clinics and who has been coordinating clinic responses to the coronavirus outbreak, agrees. In moments like these, where people have their routines interrupted and they’ve changed their eating patterns, headaches and migraines are going to be a reality for many people, she says. Viruses are known to cause headaches. It’s not entirely clear why viruses lead to headaches—it could be inflammation, it could be something else—but it’s clear that they do. “Any cold, any upper respiratory infection can give you a headache,” Dr. Mauskop says. And yes, some coronavirus patients are presenting with headaches. According to a joint report from the World Health Organization and China, data on nearly 56,000 lab-confirmed cases of COVID-19 (collection for the report stopped on February 20th) suggests that 13.6% of patients reported experiencing headaches. If you can get a headache with the coronavirus, why is it not listed among other symptoms like cough, fever, and shortness of breath? Based on data so far, headaches don’t appear to be as common as other symptoms. The WHO report suggests that upwards of 87% of people with confirmed COVID-19 cases in their report had a fever and 67.7% had a dry cough. Shortness of breath, a symptom of more severe cases, was present in 18.6% of patients. However, the WHO does consider headaches to be a main symptom of COVID-19, alongside other flu-like symptoms such as body aches, fatigue, and sputum production (the sticky stuff that comes from your lower airways). Obviously, a lot has changed since February 20 and will continue to change. One challenge about defining the symptoms of COVID-19, Dr. Fang says, is that when you describe a disease as fever, cough, and shortness of breath, experts and patients focus on spotting those symptoms. “If you don’t think to ask for headaches, maybe you won’t find it,” Dr. Fang says. Which is to say, 13.6% of patients having headache could be accurate, or it could be an over or under representation. A good example of that is anosmia—a loss of sense of taste and smell—which wasn’t associated with the coronavirus at first but has come to be considered a possible tell-tale sign of COVID-19. In late March—after the WHO-China report was released—the New York Times reported that of 2,000 positive patients surveyed in South Korea, 30% had anosmia. This is a relatively small sample size, and the patients were all mild cases. But it does highlight the important reality of just how new this virus is, and how much we’re still learning. “Before we thought to look for it, we were probably missing it,” Dr. Fang says. “Clearly we don’t know everything we’re going to know about this virus.” So, yes, headaches can be a symptom of COVID-19. “When we remember to ask about headache, we do often find that it’s present,” Dr. Fang says. But, she says, it’s not usually the most concerning complaint that patients have, and other symptoms are usually present. “If you have a fever and you have a persistent cough, just like with any other virus, might you also have headache? Yes, you could,” she explains. Another challenge is that headaches are common, period. Dr. Fang says that if a patient presented with only a headache—no fever, dry cough, or muscle aches—she might put COVID-19 on her list of possible diagnoses. “But higher up on my list would be the other reasons for headache, like migraine, which is extraordinarily common.” If you do have other symptoms, it’s important you understand what to do if you suspect you have the virus, and also how to know when it’s time to actually go to the E.R.. But headache alone isn’t likely to give you enough information. Treat your headache like normal if you don’t have other coronavirus symptoms. In mid March, France’s health minister advised that ibuprofen could further aggravate COVID-19 infections, leading to more severe symptoms. The news spread like wildfire and experts argued over how to treat the suggestion, considering no large-scale studies have been performed. At this point, the WHO says it “does not recommend against ibuprofen.” “I think that’s one of the big challenges because as physicians we’re taught to really be skeptical of anecdotal reports and to always look for double-blind randomized controlled studies to help us decide what is really effective. But in a pandemic, there’s really no time for that,” Dr. Fang says. Both Dr. Fang and Dr. Mauskop said they’ve recommended playing it safe and choosing an alternative in some instances. “It’s not dangerous to take ibuprofen, especially if you’re not feeling any symptoms of COVID,” Dr. Mauskop says. “If you have a cough and fever, maybe it’s worth staying away and taking [acetaminophen] instead.” If you’re able to manage your headache or migraine symptoms at home, that’s the best option, as health care systems are already overwhelmed right now and you don’t want to risk possible exposure to the virus if you don’t have to. There are some instances where it’s important to talk with your doctor right away if you have a headache. According to Dr. Fang, that includes people who never have headaches and all of a sudden you’ve started developing them, if your headaches are coming with other neurologic symptoms like a loss of smell or visual symptoms, or if you have a fever and a headache. Telehealth options are your best bet right now. “A lot of the evaluation for headaches is the history. A nurse or doctor speaking with a patient could really help a lot even without being able to examine them in person,” Dr. Fang explains. Lastly, to be on the safe side, a headache outside of your norm should be monitored. “If there’s something different or unusual about your headache, keep checking your temperature regularly,” Dr. Mauskop adds. Source
