From the Guidelines
For COVID-19 related headache and cerebral fog, the most effective therapy is low-dose naltrexone, as supported by substantial anecdotal reports of success within the patient community 1.
Therapies for COVID-19 Related Headache and Cerebral Fog
The treatment of COVID-19 related headache and cerebral fog involves a multi-faceted approach, considering the various mechanisms and symptoms associated with long COVID.
- Cognitive dysfunction can be addressed with cognitive pacing, similar to what is recommended in ME/CFS literature 1.
- Postconcussion syndrome protocols may also be beneficial for cognitive dysfunction, as suggested by ME/CFS and postconcussion syndrome literature 1.
- Low-dose aripiprazole has been suggested for fatigue, unrefreshing sleep, and brain fog, based on ME/CFS literature 1.
Key Considerations
When managing COVID-19 related headache and cerebral fog, it is essential to consider the potential for underlying conditions such as immune dysfunction, autonomic dysfunction, and endothelial dysfunction.
- Intravenous immunoglobulin may be considered for immune dysfunction, as suggested by ME/CFS literature 1.
- Stellate ganglion block has been reported to be effective for dysautonomia in long COVID case reports 1.
- Sulodexide may be beneficial for endothelial dysfunction, based on a long COVID pilot study 1.
Additional Therapies
Other therapies that may be considered for COVID-19 related headache and cerebral fog include:
- Coenzyme Q10 and d-ribose for fatigue, as suggested by ME/CFS literature 1.
- Pycnogenol for endothelial function, microcirculation, inflammatory markers, and oxidative stress, based on a COVID-19 pilot study 1.
- Transcutaneous vagal stimulation for autonomic dysfunction, as reported in a long COVID pilot study 1.
From the Research
Therapies for Coronavirus (COVID-19) Related Headache and Cerebral Fog
- The exact mechanisms of COVID-19 related headache and cerebral fog are not fully understood, but several hypotheses exist, including activation of astrocytes and microglia to release pro-inflammatory cytokines, aggregation of tau protein, and COVID-19 entry in the brain triggering an autoimmune reaction 2.
- A healthy lifestyle can help reduce symptoms of brain fog to some extent, and symptom-based clinical management is also well suited to minimize brain fog side effects in COVID-19 patients 2.
- Treatment recommendations for brain fog post COVID-19 encompass cognition, mood disorders, sleep disorders, and neuroinflammation 3.
- N-acetylcysteine (NAC) and acetyl-L-carnitine (ALC) are two supplements that have been found effective in treating psychiatric conditions, and may also be effective in treating COVID-19 related neuropsychiatric symptoms, including cognitive impairment and brain fog 4.
- Management strategies for cognitive dysfunction, headaches, and neuropathies in adults with neurologic post-COVID-19 conditions include clinical considerations for recognition, diagnosis, and management of neurologic manifestations 5.
- There is no reason to abandon treatment of headache patients with RAS inhibitors or ibuprofen due to concerns about a putative link between these drugs and an increased risk for COVID-19 infection 6.
Potential Therapies
- N-acetylcysteine (NAC) may be effective in relieving cognitive symptomatology in Post COVID Syndrome (PCS) 4.
- Acetyl-L-carnitine (ALC) may be effective in treating depressive symptomatology of PCS 4.
- A combination of NAC and ALC may have synergistic effects on chronic pain and neuro-astrocyte protection 4.