We know that COVID-19 has indirectly increased reports of headaches and light sensitivity—consequences from quarantine (such as more screen time and stress)—but we’re learning more about its direct impact on people actually diagnosed with the coronavirus disease. Although not the most publicly-recognized symptoms of COVID-19, recurring headaches and photophobia can be common neurological complications during and after infection.
Acute and Long-Term Headaches from COVID-19
It has been well established that headaches can be a sign of infection of the coronavirus, even recognized by the CDC in its current list of COVID-19 symptoms. According to multiple studies, the presence of head pain during the sickness period exists in anywhere between 6% to as much as 70% of patients in smaller reviews—although general consensus pegs headache reports between 10 to 30 percent.1-3
Among COVID-positive patients, the vast majority of headache complaints begin within the first 48 hours of the onset of viral symptoms, and specifically head pain manifests on both sides as a pulsing or throbbing sensation that tends to worsen with movement.4 Even those without a pre-existing headache or migraine condition described these symptoms as "distressful," "different from previous attacks," and even "incapacitating." So it is clear that these COVID-19-caused headaches have an extremely negative impact on those who experience them.
Neurologist and headache specialist Robert Belvis works in the headache unit of a Barcelona, Spain hospital and described three very specific headache types that he endured after testing positive for COVID-19 in March, 2020. He traced much of his episodic pain to diagnoses that are included in the International Classification for Headache Disorders (ICHD-3), from headache due to viral infection to “cough headache” and tension-type headache. In each of these cases, few other symptoms appeared.
Then, Belvis acknowledged another headache manifestation occurred after a week, which featured multiple migraine-like side effects—including photophobia and neck stiffness. It also persisted for longer than the previous headache types. This is consistent with other anecdotal reports from patients who had to deal with light and sound sensitivity, dizziness and other complications that resemble typical migraine but may not be so easily categorized.4
Risk factors for COVID-19 headaches
Curiously, if you have been previously diagnosed with a chronic or recurring headache disorder, there is no evidence that you are at a higher risk for developing coronavirus-related head pain. Of course, COVID-19 may aggravate your existing pain and/or affect the type or intensity of pain you experience during the infectious phase.
There are however several risk factors that researchers have identified for headache pain:3,5
- Sex, specifically female
- Loss of smell/taste during infection
- Presence of fever during infection
- Gastrointestinal symptoms during infection (e.g. diarrhea, vomiting, nausea, etc.)
What is particularly interesting is that the severity of COVID-19 illness may not directly lead to a higher risk for headaches. In fact, one study even found that patients with these symptoms may have a lower likelihood of death, and the authors suggested that it may represent a “more efficient” response by the patient’s body in fighting the virus.3
Long-term headaches after COVID-19
As previously noted, headaches attributed to coronavirus disease appear early on in the course of the illness. Thankfully, they typically resolve within a few hours or days, with some people noting that it took approximately two weeks before their recurring head pain dissipated.4 However, we are hearing from more and more experts that suggest that chronic headaches and other neurological problems may become a lingering outcome of COVID-19.
One woman described an ongoing headache of more than 80 days after the resolution of her COVID-19 sickness. She originally developed a typical COVID-associated headache within the first few days of infection, but it morphed into head pain with migraine-like features. It ranged from moderate to severe and was frequently accompanied by photophobia and/or phonophobia, leading doctors to suggest that it was probable new daily persistent headache (NDPH) because of its association with viral infection.6
Dr. Valeriya Klats, a neurologist and headache specialist with the Ayer Institute Headache Center in Stamford, Connecticut, also supported the presence of these long-term headache complications in some of her patients.
"We’re seeing a small subset of people who have prolonged headache symptoms long after their acute illness is over," she said in an article for Hartford Healthcare. "This can either be episodic or an all-day, everyday headache. The way we describe this is the new ‘daily persistent headache.’ It’s very bothersome to patients."
A self-organized group of COVID-19 patients have also looked into the negative neurological impact of the disease over time, and they found that a small—but not insignificant—percentage of patients (~10%) have headaches at and beyond six weeks post infection.7
Light Sensitivity and Eye Symptoms of COVID-19
While not nearly as prevalent as headache pain, light sensitivity (or photophobia as it can be called) and other ocular symptoms can occur during the acute COVID-19 infection period as well as in the weeks after recovery. Estimates have suggested that around 10-15% of patients develop photophobia during the core symptomatic phase, with some researchers even finding that it is the most common eye symptom of the coronavirus disease.8,9 Even among people who had endured sensitivity to light previously as a result of migraine called its appearance during their COVID-19 illness "very disturbing," which truly underscores how disabling and harmful it can be, regardless of cause.
Here is a shortlist of frequent ocular complications as reported by patients:
- Light sensitivity, photophobia
- Eye pain
- Dry eyes
- Blurred vision
- Flashes or floaters
- Irritation or redness
- Excessive tearing
We also cannot overlook the fact that many of these issues can independently lead to sensitivity to light, and the presence of multiple ocular symptoms may just enhance that likelihood. If one already has head pain with migraine-like features, then photophobia is very much a probable complaint to follow. Also, like headaches, these COVID-19 eye symptoms (including light sensitivity) show up within the first 2-3 days after infection.10
In addition, conjunctivitis, or pink eye as it is more commonly known, seems to be a central piece of the photophobia puzzle. Not only is it an established cause of sudden onset light sensitivity, but it now has been linked to COVID-positive individuals and in fact may represent the lone precursor symptom in a small number of cases. It also is more likely to affect those who deal with more serious coronavirus infection.11,12
It is probably not too surprising that the eye is so prominently affected since the virus is detectable within tears and has been shown to be a direct pathway for the virus to enter the body. It further reiterates why a common prescription for safety involves the avoidance of rubbing or touching one’s eyes without properly sanitizing your hands. Specific risk factors for COVID-related photophobia have also been identified, notably older age, pre-existing eye disease and higher fever—although more research is needed in this area.9
Long-term light sensitivity after COVID-19
Currently, not much evidence exists to help us better understand if and how light sensitivity persists after the acute coronavirus infectious period. As you might imagine, if headache and eye symptoms endure for weeks or months following recovery, then there certainly is a higher probability of sensitivity to light as well—especially if it, in any way, resembles migraine. One patient-led analysis showed that approximately 10% of people surveyed had photophobia at least six weeks after the illness, while another small study indicated that one out of every four COVID-19 patients had continuous ocular symptoms in spite of their recovery from the virus.7,8 Still, as experts are learning more about the outcomes of this disease, we have a long way to go before we fully realize the long-term impact of COVID-19 on the brain and eye health of those who suffer from it.
Treatment for post-COVID headaches and photophobia
The first step to dealing with these physical consequences of COVID-19 should involve consulting a medical professional, particularly if these symptoms are new and severe. While more specific recommendations are not yet available for those issues directly caused by the coronavirus, they may be able to suggest common headache or migraine remedies as well as options for treating light sensitivity, such as TheraSpecs blue light glasses and other lifestyle modifications.
1Belvis R. Headaches During COVID‐19: My Clinical Case and Review of the Literature. Headache: The Journal of Head and Face Pain. 2020;60(7):1422-1426. doi:10.1111/head.13841.
2Bolay H, Gül A, Baykan B. COVID‐19 is a Real Headache! Headache: The Journal of Head and Face Pain. 2020;60(7):1415-1421. doi:10.1111/head.13856.
3Trigo J, García-Azorín D, Planchuelo-Gómez Á, et al. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. The Journal of Headache and Pain. 2020;21(1). doi:10.1186/s10194-020-01165-8.
4Toptan T, Aktan Ç, Başarı A, Bolay H. Case Series of Headache Characteristics in COVID‐19: Headache Can Be an Isolated Symptom. Headache: The Journal of Head and Face Pain. 2020;60(8):1788-1792. doi:10.1111/head.13940.
5Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002-1009. doi:10.1136/gutjnl-2020-320926
6Rocha‐Filho PAS, Voss L. Persistent Headache and Persistent Anosmia Associated With COVID‐19. Headache: The Journal of Head and Face Pain. 2020;60(8):1797-1799. doi:10.1111/head.13941.
7Report: What Does COVID-19 Recovery Actually Look Like? Patient Led Research. https://patientresearchcovid19.com/research/report-1/. Accessed September 7, 2020.
8Gangaputra SS, Patel SN. Ocular Symptoms among Nonhospitalized Patients Who Underwent COVID-19 Testing [published online ahead of print, 2020 Jun 22]. Ophthalmology. 2020;S0161-6420(20)30574-1. doi:10.1016/j.ophtha.2020.06.037
9Ceran BB, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefe's Archive for Clinical and Experimental Ophthalmology. 2020;258(9):1959-1963. doi:10.1007/s00417-020-04777-7.
10Rokohl AC, Loreck N, Matos PAW, et al. More than loss of taste and smell: burning watering eyes in coronavirus disease 19 (COVID-19). Clinical Microbiology and Infection. 2020. doi:10.1016/j.cmi.2020.08.018.
11Scalinci SZ, Battagliola ET. Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases. 2020;20. doi:10.1016/j.idcr.2020.e00774.
12Loffredo L, Pacella F, Pacella E, Tiscione G, Oliva A, Violi F. Conjunctivitis and COVID-19: A meta-analysis [published online ahead of print, 2020 Apr 24]. J Med Virol. 2020;10.1002/jmv.25938. doi:10.1002/jmv.25938
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