S3:Ep32 – Long Haul COVID and Headaches


Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

This episode is brought to you in part by our generous sponsor, AbbVie.

Molly O’Brien: Hello, and welcome to Spotlight on Migraine. I’m your host Molly O’Brien. Today we’re discussing long COVID and migraine and headaches. So not a ton of research out there, seeing that we’ve been in the pandemic for under two years, but there is a lot of progress, and we are learning more. 

So I’d like to welcome our guests today. I’m very excited to chat with them. They are both from the long-COVID initiative at the Brown School of Public Health. We have two guests today. Dr. Philip Chan is an associate professor in the Department of Medicine. Dr. Chan is also an infectious-disease physician and a medical director at the Rhode Island Department of Health. 

We also have Dr. Laura Chambers joining us. Dr. Chambers is an adjunct assistant professor of epidemiology in the Brown University School of Public Health. She’s a post-doctoral research fellow in The Miriam Hospital Division of the Infectious Diseases and the Brown University Department of Medicine. 

So, Dr. Chan and Dr. Chambers, thanks so much for joining us today. We’re happy to have you here.

Dr. Philip Chan: Thank you for having us.

Dr. Laura Chambers: Thank you for having us.

Molly: And I’m really excited about the work that’s happening with the long-COVID initiative at Brown University. We’ll talk a little bit more about some of the work that you’re doing there, but let’s dive into the topic of long COVID and headache. Again, COVID has been around it seems like forever, but relatively new when we’re doing research and studying and finding out the long-term effects. So let’s talk a little bit about what we know so far about the relationship between migraine headache and COVID-19.

Dr. Chan: Yeah, thank you so much, Molly. It’s a pleasure to be here. Thank you for hosting and for the invitation. 

I will say that we’ve known that headaches are a very common cause [sic], not just of COVID-19, right, but of many infections in general — respiratory illnesses, the flu, right, influenza — and really a whole lot of different diseases and infections. So when COVID first hit us — and I agree with you; it seems like forever. I’m reminded that it hasn’t even been two years yet, but it feels like forever. It’s not surprising that headaches were a pretty common symptom of acute COVID-19.

And so a lot of people do, when they get COVID, have headaches, of course, with fevers, chills, malaise, respiratory symptoms — it’s really been, of course, one of the key manifestations. But headaches are really common in people who have acute COVID. And then as we’ll get into, of course, people with longer-term COVID symptoms, there is a percentage of people who do have persistent headaches from COVID-19, potentially. And then, of course, in people who have migraines or other chronic diseases, it can potentially exacerbate and make those worse.

Molly: Is there any one type of person or someone in particular that’s more likely to develop long COVID?

Dr. Chambers: So, generally, long COVID can impact anyone who has been infected with COVID-19. However, emerging evidence suggests that some people are more likely to develop long COVID than others if infected. For example, people who had more severe illness during the initial infection seem to be more likely to develop long COVID, as do those with certain underlying health conditions. In one study, headache was among multiple COVID-19 symptoms that were most strongly associated with developing long COVID. However, additional research is definitely needed to kind of understand what factors may place someone at higher risk for developing long COVID generally, and then long-COVID headaches, specifically. 

But one very important note is that given the disproportionate impact of the COVID-19 pandemic on communities of color, we expect that long COVID too may be affecting people of color more than whites. So it’s critical that we understand the equity implications of long COVID and that we work with patients and communities to determine how to best support people with long COVID and ensure access to high-quality and affordable care.

Molly: One hundred percent. I’m curious, if we can explore that a little bit more, is there any indication — you said that there could be, but we need more research — but is there any indication that someone with an underlying headache disorder could be at higher risk for developing long COVID and then seeing potential more headache or anything down in the future?

Dr. Chambers: So the reality is that we don’t know yet. As Dr. Chan mentioned, there is some evidence that COVID-19 infection can adversely impact people who already experienced migraines or headaches, particularly through either increasing the frequency or severity of headaches. However, we need to understand how common that is and how long those kind of worsening headaches may last. So these are really important questions for ongoing and future research.

Molly: Well, it’s good to know that people like yourselves are looking into this kind of stuff. It would seem to make sense that a virus like this would exacerbate something that’s already happening within the body, right? If you have a persistent headache or if you have chronic migraine, I mean, it almost makes sense, but I don’t want to put anything past this virus, because a lot of it doesn’t make sense.

All right. So let’s talk a little bit about what we know about COVID-19 and how it can actually cause long-COVID headaches.

Dr. Chan: Yeah, so that’s a great question, and I think really one of the themes, I think, for people to take away is that we’re still learning a lot. Again, this is such a new virus. There’s still so much to learn, and just about some of the causes of headaches in general. 

We know of course that the brain itself does not have pain receptors, and, therefore, right, the headaches are the result of pain really originating from structures around the brain, right — the blood vessels; the meninges, which is the covering of the brain; muscle fibers; potentially, facial structures; and certainly some of the nerves that come out of the brain, what we call cranial nerves, the ones that kind of go to the face, or spinal nerves, certainly, throughout the body — and that any sort of stretching or dilation or constriction, any sort of effect on those nerves or structures, what really causes pain, which, of course, can result in headaches. 

And so there’s a lot of potential ways, potentially, that COVID could impact and cause headaches. And I think what we’ve seen, what we know so far from other manifestations of COVID, we know that COVID can obviously ramp up, activate the immune system — overly activate the immune system, if you will — and that certainly an overactive immune system can actually cause a number of symptoms. So that could be part of it. 

There’s also, potentially, direct damage by the virus itself. We know that the virus tends, of course, to affect the lung receptors and infect the lung, but that also doesn’t mean that it may infect other cells as well and cause some of that damage.

So I think there’s still a lot that we’re learning, a lot that we need to know, especially as it pertains to headaches, so more to come in that.

Molly: Wonderful. But, again, it’s nice to know that people like yourselves are starting to piece this together and we’re getting a clearer understanding. Obviously, it’s still early in this, but we’re getting a better understanding. 

So now that we know a little bit about how, potentially, COVID-19 could affect headache in long COVID, let’s talk about ways that we can treat it. Do we have any ideas on how we can either treat these headaches when it comes to long COVID or — and then we’ll get into how we can prevent them.

Dr. Chambers: Yeah, so, unfortunately, evidence-based management approaches for long COVID are limited. Currently long-COVID headaches are often managed using an interdisciplinary approach, so a variety of different specialties, particularly because people may be experiencing other symptoms of long COVID in addition to headaches. So management may include medications, rehabilitation, and psychological support, including the types of tools that we typically use to manage headaches outside of the COVID context.

Molly: Do we know at all, or is there any evidence, or do we have an inclination that someone who might have an underlying headache disorder like chronic migraine, can they see relief from these long-COVID headaches by using their migraine medication? Is that something that’s being looked into at least, just another tool in the toolbox, as we like to say?

Dr. Chan: Yeah, I can take that one, and the answer is yes. So we do believe that, certainly, symptoms of long COVID may be due, initially, right, to the virus, but it’s not due to continuous infection, meaning that if you try to treat the virus itself in people’s long COVID, we don’t expect that to have any impact. And so that really means that — I think, to your question, Molly — that really symptomatic treatment, so using the same medications to treat a person with migraines or just headaches in general, is that that’s what we’re doing now in terms of treating, really, all the symptoms of long COVID, but including headaches.

Molly: OK, and I think that’s helpful to know as well to put in perspective, because if someone with an underlying headache disorder has a regimen that works for them, if they do unfortunately develop long COVID, to at least have some idea of how they can manage pain in the future. So that’s good to know.

So [crosstalk] —

Dr. Chan: And I think, Molly, too, if I could just interject, I think too that that’s an important point of how we’re thinking about approaching long COVID, meaning it’s kind of this what we would call a “multidisciplinary approach.” So, long COVID can present with many things — lung complications, heart, neurological, migraines, as we’re talking about. And most clinics now, infectious disease clinics, who have long-COVID programs — and I can speak specifically about the clinic here in the state of Rhode Island run by my colleagues Dr. [inaudible] and Dr. Johnson. 

But it is a multidisciplinary approach where you do have neurologists who are involved to help treat things like migraines, or cardiologists for heart. So it’s really part of this multidisciplinary approach to understand and also treat and manage these chronic symptoms.

Molly: That’s incredible that we’re tackling this from all angles, and it seems like we have to, but we are getting there. 

So we talked a little bit about how possible headaches are developed through long COVID, some treatment options. Let’s talk about ways we can prevent developing long COVID and headaches associated with it.

Dr. Chan: Yeah. So that’s a great question, Molly. And so I’ll take that one, and, Dr. Chambers, if you have anything to add. But I’ll just say, we know, first off, that vaccines are so effective, and so if I could really push and emphasize, highlight one thing, it would really be vaccines, vaccines, vaccines. They work, they work against the Delta variant. They work against all the variants that we know. They’re incredibly effective. So vaccinate, vaccinate, vaccinate.

And I think in terms of — again, we’ve learned so much during the pandemic. Wearing a mask, again, it’s recommended during times, by the CDC, when there’s higher levels of COVID in the community to wear masks indoors, especially, in public places, when you’re around other people. That seems to make sense. 

And then other things that we’ve learned too — physical distancing, appropriate ventilation, and getting routinely tested, and making sure, of course, that if you have symptoms, that you should not interact with others. You should not go to work. You should not go to school.

So these are really kind of the key pillars of preventing COVID in general, and this is one of the things, too — there are a number of people out there, maybe some listening to this podcast here, they may be a little bit hesitant about getting vaccinated, and this is one of the reasons why I got vaccinated. So, certainly, as a physician, I got vaccinated to prevent COVID, prevent transmission to my patients, my family, to others. But just on a personal, individual level, I don’t want COVID because I’m worried also about long COVID, including things like chronic headache.

So even if you have been hesitant to get the vaccine, I really do believe that the benefits of vaccination –not just to others around you, but also you yourself — really greatly outweigh any potential risks.

Molly: So now that we know a little bit more about that and we have a better understanding of how we can prevent long COVID by preventing getting COVID in the first place — take those necessary steps, please. If you’re listening at home, save yourself the hassle and save yourself some pain and help protect the community around you as well. 

So there’s still a lot that we need to know about COVID-19 in general, but what do we still need to learn about long COVID and long-COVID headaches?

Dr. Chan: There’s still a lot to learn. I’ll just echo and highlight what Dr. Chambers has mentioned. Again, such a young disease here. I mean, we’re even having trouble understanding who’s at risk, how many people are really at risk for long COVID itself — certainly for the headaches — and just really how to treat and manage it. What are the best management and treatment approaches for this? What’s the impact of long COVID on quality of life, social wellbeing, older people, different age groups. As Dr. Chambers mentioned, different racial ethnic groups may be disproportionately impacted.

So still so much to learn, and especially, I think, too, from the business setting, how do we as a culture, as a society, think about long COVID as employers? As healthcare systems, how do we support people to really have the best health outcomes and quality of life for everyone?

Molly: So we mentioned before that you’re both from the Brown University long-COVID initiative. Can you tell us a little bit more about what’s happening over there, what are you looking into, and then how it can help us answer these potential questions we have about long COVID and its link with headache?

Dr. Chambers: Of course. So we are rapidly studying the impacts of long COVID on people, communities, workplaces, healthcare, and society as a whole. So much of our work thus far has focused on evidence synthesis, so kind of digesting and summarizing the information that’s currently available and then communicating it quickly and clearly for different audiences. So this includes patients and clinicians, policymakers, employers, healthcare payers, and other health system leaders.

So part of this is, of course, summarizing emerging clinical evidence, but as Dr. Chan mentioned, we also aim to characterize the social and economic impacts of long COVID and develop recommendations to help prevent and mitigate those impacts. So we’re doing this through multiple different ways, so including surveys with patients and employers, mathematical modeling to estimate societal impacts, and stakeholder roundtables to develop kind of interim best practices and a high-impact research agenda. So these roundtables will include the types of stakeholders that I just described, so definitely patients, clinicians, employers, policymakers, payers and other health system leaders, given the kind of broad impact that long COVID has on our society.

Molly: It’s pretty exciting to hear about the broad-spectrum approach that you’re taking investigating long COVID and its implications, but also still looking at — really crunching those numbers and looking at the data on specific points. And I think you made a great point that you’re working to disseminate this information that you’re gathering rapidly. 

So as we kind of wrap up here — I really appreciate both of your time — is there anything else that either of you would like to touch on when it comes to long COVID and headache?

Dr. Chan: I think I’ll just mention, one thing that’s really exciting about this is that we are synthesizing this data and the real goal is to give people hope. And I don’t want to underestimate the importance of people suffering from long COVID. I mean, I’ve seen several stories of patients with long COVID. We know it’s a real thing. It’s been well described. 

And so our goal at the end of the day is really to try to make a difference for people suffering with long COVID, whether it be headaches or other things. But it is a real thing, and so I just want to acknowledge that and mention that the entire goal is really to try to improve the life and have a better understanding and work towards new treatments. 

And one thing that’s really happened during the course of the pandemic is that there’s thousands and thousands of scientific studies now happening for many things, including long COVID, and what’s been confusing is trying to synthesize all this data, bring it all together, look at what’s working, do some of these more complex statistical analyses. And that’s the goal of what we’re trying to do is really bring all the information together to understand it, to synthesize it, and to come up with best practices and recommendations, with the ultimate goal, of course, of helping people with long COVID.

Molly: And I think you hit the nail on the head, too, providing some hope for people out there. Hope is a big part of the migraine community, just looking forward to the next day, whether it’s being pain-free or having less pain. So we really appreciate the work you’re doing, and we’re so glad to have you here today. 

And that wraps up this episode of Spotlight on Migraine with the Association of Migraine Disorders. I’d like to thank our guests today. I know I learned a ton. I hope you at home watching or following along have learned a ton as well. So thank you to Dr. Philip Chan and thank you to Dr. Laura Chambers with Brown University. We’re so glad to have you here today.


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