Summary

Through reading related medical papers on long COVID chronic headache so far, the author summarized the life performance of long COVID chronic headache, and provide an in-house self assessment to judge whether people develop chronic headache symptoms.

Then, the author analyzed the pathogenesis of the long COVID chronic headache, and concluded the approaches of western medicine treatment against long COVID chronic headache. Due to the limitation of western medicine treatment against long COVID chronic headache, this paper also recommended some traditional Chinese medicine, including Chinese medicine formula and acupuncture treatment, to treat the headache-related symptoms.

In addition, this paper made advises patients with long COVID chronic headache on taking health care products, as well as on exercise, diet, and sleep.

In the end, we hope that the treatment program for long COVID chronic headache suggested in this paper could benefit patients by improving their symptoms in the brain as soon as possible, and even cure the chronic headache caused by novel coronavirus infection.

Keywords: Long COVID,Post Covid-19, Post Covid-19 headache, long COVID chronic headache, long-term COVID-19 headache, long-term COVID-19 dizziness

1.What are the manifestations of long COVID chronic headache?

A large proportion of long COVID symptoms are related to the brain. In order to facilitate the unified classification and description of Long Covid symptoms related to the brain, the medical community uses a folk colloquial vocabulary, namely, brain fog. Brain fog has not been a medical or scientific term previously, but rather a colloquial description of a state in which people cannot think normally and clearly when they develop influenza or other diseases.

Common people describe problems arising in their usual cognition or thinking by picturing the fog in their brain, such as difficulty in concentrating, memory loss, thinking slower, inability to think acutely, without creativity, and difficulty in making plans. During rehabilitation after being infected with COVID-19, many patients said they experienced "brain fog". According to figures given in the study report, about 1% of patients infected with novel coronavirus would experience symptoms of brain fog.

At present, the medical community has accustomed to classifying chronic headache caused by the novel coronavirus infection as long COVID of brain fog. According to statistics in the study report, patients with chronic headache accounted for one-fourth of all patients with brain fog. That means about 0.25% of people infected with the novel coronavirus would experience chronic headache. According to published medical papers on long COVID chronic headache, we conclude that the manifestations of chronic headache are as follows:

(1) Chronic headache: feel chronic headache throughout the whole brain, or symmetrical chronic headache bilaterally in the brain; frequent feel of fever and tightness in the head. Some presented with tension headaches or migraines.

(2) Brain fatigue: feel that it is easy for the brain to be tired; feels listless; it is easy to feel tired when pondering;feel easily sleepy when reading, and feel sleepy easily during the day.

(3) Brain dizziness: feeling dizzy, vertigo, fear of sunlight, and hearing loss.

2.How to judge whether people suffered the long COVID-19?

What are Post-COVID Conditions? According to the definition of the World Health Organization, Post-COVID Conditions, also known as Long Covid, long-haul COVID, post-acute COVID-19, It refers to the patient who is infected with the new coronavirus, the first PCR test is positive, and after 3 months, there are still symptoms of physical discomfort. For more detailed information on the latest statistics on the incidence of long covid according to the time axis, please refer to the following figure.

Post Covid-19 Symptoms mainly concentrated in five aspects, including respiratory syndrome, cognitive system syndrome, chronic fatigue syndrome, chronic pain syndrome, and mental syndrome. Long-term COVID-19 brain fog is belonging to the cognitive system syndrome.

If you have a history of COVID-19, which means your previous result of PCR test showed positive, and before infection with the novel coronavirus, you didn’t suffer from the long COVID brain fog, but now you are presenting these symptoms mentioned in the above section, you are likely to afflict by Long Covid brain fog.

3.What are the causes of the long COVID chronic headache?

According to the published medical papers on the long COVID chronic headache, we concluded that there are five conditions in the pathogenesis of the long COVID chronic headache as follows:

(1) For patients infected with novel coronavirus, they may have experienced immune cytokine storm and severe fever during the infectious period, because some studies have confirmed to have fever as a cause of chronic headache in long covid. Studies have also shown that arterial hypertension occurs after the patients experienced cytokine storm, which is also one of the causes of the long COVID chronic headache.

(2) Among patients infected with novel coronavirus, some people would experience novel coronavirus breaking through the blood-brain barrier and invading the brain. Studies have confirmed that the virus can break through the blood-brain barrier of the human body and infect cells in the brain, causing neurodegeneration to further develop into neuroinflammation in the brain. This is also one of the causes of chronic headache. Some patients with long COVID chronic headache also have been observed with images of brain damage when taking CT.

(3) For patients infected with novel coronavirus, some would develop systemic chronic inflammation. Some studies have shown that proinflammatory substances triggered by systemic viral infections, NLRP3, HMGB1, and interleukin 6, are the cause of chronic headache.

(4) For patients infected with novel coronavirus, if they had experienced severe cases during the infectious period, such as hypoxia, or experienced the coronavirus invasion of into the brain, causing blockage of the brain's microvessels, they would present the symptoms similar to minor ischemic strokes or hemorrhagic stroke, which can cause chronic headache.

(5) Studies have shown that sometimes the COVID-19 infects the eye, causing damage to retinal nerve cells and neurons in the brain pathway, which may also cause chronic headache. Sometimes the coronavirus infects the nasal cavity, causing damage to olfactory sensory neurons to decrease lymphatic circulation in the brain, which can also cause chronic headaches.

Through performing PET (positron emission tomography, which can determine the development of diseases by detecting the metabolic level of the human body) imaging analysis among the brains of 15 patients with novel coronavirus pneumonia who were in the subacute phase and presented abnormal olfaction and taste, the team of professor Jonas A. Hosp from the University Medical Center Freiburg in Germany found that 10 patients had decreased metabolic levels in the frontoparietal lobe.

The E Guedj team from the Department of Nuclear Medicine of University of Aixes-Marseille in France also applied PET to detect metabolic changes in the brain of two patients with novel coronavirus pneumonia to find reduced metabolic levels in some sites, including the olfactory/rectus gyrus, amygdala, hippocampus, and parahippocampus.

The Gwena ëlle Douaud team from the Wellcome Centre for Integrative Neuroimaging (WIN) of University of Oxford in the UK systematically analyzed brain imaging data from 401 patients with coronavirus infection before and after infection, finding that coronavirus infection caused a more reduction in gray matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus (associated with olfaction and memory), more tissue damage in areas associated with primary olfactory cortex function, and more reduction in brain volume. The findings were published online on March 8, 2022 in Nature.

4.How to treat the long COVID chronic headache?

At first, we need to take a thorough physical examination of our bodies, and besides taking routine examinations, we need to do another three examinations.

The first item: do several more PCR tests, and nasal and throat secretions should be dipped enough to see whether the result shows positive. If it shows positive, it means there is still some active novel coronavirus in the body.

The second item: perform a CT image of the brain to see whether there is imaging evidence of a brain scan that resembles Alzheimer's or Parkinson's symptoms.

The third item: test specifically whether the amount of p-tau217 protein in the blood exceeds considerably the person's average criteria. The result in excess means the brain is in the early stages of Alzheimer's disease.

Secondly, the results of the above comprehensive physical examination and three special examinations should be handed over to the doctor, and then the patient should communicate with the doctor to describe one’s own long COVID memory loss symptoms in detail.

Then, the doctor can design the best treatment for you. Because the situation varied from person to person, after the interview the treatment plan given by the doctor is also different, so we cannot give a general treatment plan in this article.

The rough ideas for designing the treatment plan are as follows:

(1) According to the results of the patient's comprehensive physical examination and three special examinations as well as the communication with the patient, find out the most likely pathogenesis of the patient's long COVID chronic headache.

(2) Prescriptions are prescribed for treatment according to the pathogenesis and the patient's physical condition.

(3)For the main direction of medication are: if novel coronavirus still remains in the body, antiviral drugs such as Paxlovid should be used as a priority. If there is no virus in the body, the drug is used from the perspective of reducing or eliminating the chronic inflammation of the patient, reducing the autoimmune phenomenon of the patient, eliminating microclots to improve the capillary microcirculation of the patient, improving the metabolic circulation of the patient, protecting the patient's brain nerves and repairing the patient's nerves.

(4) For the symptoms that seriously affect the work and life of patients, some drugs for improving the experience of symptoms can also be used according to the specific symptoms, such as drugs for invigorating the brain, refreshing the brain, stimulating the nerves, and other effects.

(5) Oxygen therapy and brain physical massage can also be tried, and studies have shown that these two methods are also beneficial in removing chronic headache.

 

(6) If patients suffer from psychiatric symptoms such as insomnia, anxiety, and depression, they should seek help from psychologists and TCM to eliminate these psychological symptoms. This method is also helpful in removing long COVID chronic headache.

5.How to treat long COVID chronic headache from a traditional Chinese medicine(TCM) perspective?

From the theory of syndrome differentiation and treatment of TCM, the treatment of long COVID chronic headache can obtain more accurate TCM syndrome differentiation and more suitable TCM formulas from the following three steps.

(1) Perform the observation, smelling, hearing, and inquiring of traditional Chinese medicine diagnosis, and consult the comprehensive physical examination report and three special examination reports of western medicine in the previous section at the same time. Only in this way can TCM doctors obtain the most detailed disease information of patients to support them to make the most accurate syndrome differentiation and treatment of patients' conditions.

(2) TCM doctors will classify and summarize the main symptoms, accompanying secondary symptoms, physical condition, and sick parts of the internal organs of the patients according to the most comprehensive disease information of the patients.

First, the main symptoms are the most unbearable symptoms of patients at present, such as chronic headache of long COVID brain fog, or memory loss of long COVID brain fog, and dizziness of long COVID brain fog.

Second, accompanying secondary symptoms are that suffered from the main symptoms, the patient is experiencing other uncomfortable symptoms, such as feeling fatigued in a short time when using the brain, suffering from insomnia, anxiety, depression, and so on.

Third, to find out the physical condition of the patient, which means the patient's current physical health status, belongs to which category in the TCM constitution. For example, yang-deficiency constitution, phlegm-dampness constitution, qi-deficiency constitution, blood stasis constitution, etc.

(3) TCM doctors, according to the above summary, combined with the internal organs and meridians related to symptoms, comprehensively use the theory and practical experience of TCM to make TCM prescriptions for patients. If acupuncture and moxibustion are required, these programs will also be prescribed.

Traditional Chinese medicine (TCM) theory is mainly based on: Zhang Zhongjing’s “Treatise on Febrile Diseases”, “Synopsis of Golden Chamber”, Huang Yuanyu's “Four Sacred Hearts Source”, “Typhoid Fever Suspension”, “Jinkui Suspension”, “Changsha Yao Jie”, Li Dongyuan 's “Treatise on the Spleen & Stomach”, and Zhang Jingyue' s “Jingyue Quanshu”.

TCM Practical experience, which can be found in Google Scholar (Fig. https://scholar.google.com/), and search for keywords for TCM treatment of long-term novel coronavirus symptoms. For example， COVID-19 Traditional Chinese Medicine, Long Covid Traditional Chinese Medicine. A large number of academic papers on medical research on the treatment of Long Covid by traditional Chinese medicine can be found in this way.

In order to make it easier for everyone to understand the treatment process of TCM, the following is a TCM treatment case of a patient with long COVID chronic headache

Case 1:

Name: Wang, male, 57 years old, height 170cm, weight 80 kg.

MEDICAL HISTORY: PCR was positive for novel coronavirus on 10 Mar 2022, followed by typical symptoms of novel coronavirus infection: fever, cough, sore throat, sputum with blood streaks, ageusia, and anosmia. Two weeks later, the symptoms of novel coronavirus infection gradually relieved and disappeared. Later, long COVID chronic headache appeared successively.

Physical examination report of western medicine: (1) The PCR test result of novel coronavirus showed negative again. (2) High blood glucose and early symptoms of type 2 diabetes appeared. (3) Brain PET (positron emission tomography, which can determine the occurrence and development of diseases by detecting the metabolic level of the human body) imaging analysis revealed images of decreased metabolic levels. (4) Proinflammatory markers were high and there was slight systemic chronic inflammation. (5) The content of p-tau217 protein in blood was five times higher than that in the average person.

Main symptoms: recurrent chronic headache, feel tight in the head, occasional fever in the head, and occasional dizziness.

Accompanying secondary symptoms: soreness and weakness of the waist and knee, general weakness, anxiety, depression, and depressed mood.

TCM constitution: the body presents phlegm-dampness constitution and blood stasis constitution.

TCM diagnosis evaluation: The body before the novel coronavirus was in a sub-health state, obesity, and after the infection with novel coronavirus, the sub-health state deteriorated, presenting phlegm-dampness congestion, chronic headache, and other symptoms.

The prescription was given by the herbalist:

(1)Gastrodia elata headache tablets are used to reduce chronic headache and are used to treat partial headache caused by blood stasis.

(2) Mailuotong capsules are used to dredge meridian vascular congestion.

(3) Chaihu plus Longgu oyster Tang are used to improve insomnia anxiety.

(4) Qingtan Yizhi Tang is used to remove phlegm and dampness and refresh the brain.

Acupuncture program given by the TCM: Using an electronic moxibustion device, moxibustion on the following acupoints.

(1) Baihui, Neiguan, Taixi, and Yongquan points are stimulated by moxibustion to improve cerebral blood circulation and metabolism.

6.Which kind of health products are beneficial to improving long COVID chronic headache?

Taking the patient above as an example, we give the following health product recommendations based on her condition:

(1) Omega 3 (Ω3) fatty acids, containing high amounts of DHA and EPA, are used to improve brain function and protect against cardiovascular and cerebrovascular diseases.

(2) Comprehensive vitamins, mainly VC, VD, and VB, are used to scavenge free radicals, anti-oxidation, and reduce systemic chronic inflammation.

(3) Curcumin is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.

(4) Sulforaphane is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.

(5) Melatonin is used to improve sleep quality.

(6) American ginseng is sliced for making tea or taken American ginseng capsules to replenish qi.

7.What exercises are beneficial to improving long COVID chronic headache?

Taking the patient above as an example, we give the following exercise advice based on his condition:

(1) Take moderate aerobic exercise at least three times a week, such as walking and jogging to remove phlegm-dampness.

(2) With the utility of gym equipment, strength training is performed for the major muscle group to improve insulin activity and lower blood glucose.

(3) Assist head massage.

8.What is beneficial to improving long COVID chronic headache in terms of diet and sleep?

Taking the patient above as an example, we give the following diet and sleep advice based on his condition:

(1) Control carbohydrate intake, which means reducing the amount of staple food such as rice and noodle, to control of animal fat intake.

(2) Do not take any food after lunch, and have breakfast and lunch only a day. Losing weight at least more than 10% of body weight, which means losing 8 kg, reducing the degree of obesity.

(3) Bubble bathing until slightly sweating before sleeping, and lie in bed to do general muscle tightness and relaxation training, improving sleep quality.

9.Patients with long COVID chronic headache are welcome to contact with our Long Covid Care Center

If there are similar symptoms among readers, contact our Long Covid Care Center for assistance.

Phone: +852 5765 5768

Whatsapp: +852 5765 5768

WeChat: longcovidcarecenter

Email: support@longcovidcarecenter.org

【Disclaimer: The treatment of diseases is a very complex and professional affair. Due to the limitation, Long Covid Care Center can only carry out remote simple interviews, unable to face-to-face offline interviews and obtain comprehensive physical examination results. Therefore, the suggestions, guidance, protocols, and documents conveyed by our Long Covid Care Center to patients can only be used as a reference for patients to understand their diseases in many aspects, but cannot be directly used as a treatment plan. Patients must discuss their symptoms with doctors in local hospitals through face-to-face communication. After the patients completed the physical examination required by doctors, they would get a prescription issued by doctors and get the treatment under the guidance of doctors. Therefore, Long Covid Care Center hereby declares that our center is completely exempted from liability when any adverse consequences are caused by self-treatment of the patient for applying any contents convoyed by the center, that is, we do not bear any responsibilities.】