What is Long Covid?

The SARS-CoV-2 pandemic has affected a lot of people in the last two years. Science has made progress in understanding the development and treatment of acute SARS-CoV-2 infection. In recent months, another condition has emerged: the so-called long COVID syndrome.

Long-Covid describes the effects and long-term symptoms of Covid-19 that last for weeks or months after illness. The World Health Organization (WHO) defines Long-Covid as symptoms

  • which usually occur three months after the onset of Covid-19,
  • which last at least two months and
  • that cannot be explained by another diagnosis.

Studies show two main categories of persistent symptoms in Long Covid:

  • a larger group with a range of more general symptoms, particularly chronic headaches, tiredness and fatigue, tingling, numbness and "brain fog", heart palpitations and rapid pulse
  • a smaller group of people with respiratory symptoms such as cough or shortness of breath (this group was initially more likely to have severe Covid-19 disease).

How many are affected by Long Covid?

More than four out of ten (42 percent) people suffered from Long Covid symptoms more than a year after their corona infection. Almost two-thirds (63%) said their symptoms had affected their ability to carry out everyday activities.

What are the symptoms of Long Covid?

Long Covid can occur for a long time or periodically in cycles. Things get better for a while and then they get worse again. These long-term effects are not only seen in those who had to be hospitalized or who felt very bad when they first contracted the virus. Persistent symptoms of coronavirus may include:

  • Headache
  • fatigue
  • Shortness of breath or shortness of breath
  • Difficulty sleeping
  • Anxiety and depression
  • heart palpitations
  • Chest tightness or pain
  • Joint or muscle pain
  • Inability to think clearly or concentrate ('brain fog')
  • Change in sense of smell or taste
  • Persistent cough

Does vaccination against Covid-19 reduce the risk of long Covid?

Yes - there is plenty of evidence that vaccination reduces the risk of developing long Covid. The British Health Authority (UKHSA) evaluated 15 international studies on Long Covid. It found that people who became infected with Covid after two doses of the Pfizer, AstraZeneca or Moderna vaccine or one dose of the Janssen vaccine were only half as likely to develop long Covid symptoms. This study only included people examined those who have been infected with the corona virus. Because vaccination also reduces the risk of contracting Covid, the actual reduction in long-term risk of Covid from vaccination is much greater.

Can Covid-19 cause headaches?

Many studies have shown that Covid-19 can cause headaches. Some people even get headaches before they notice breathing problems. Headaches are one of the most common symptoms of Covid-19. Headaches are often a symptom of acute viral infections. However, they can persist even when the virus is no longer active in the body.

Viral infections can worsen a pre-existing migraine; the attacks may occur more frequently or the pain may last longer than usual. People who suffer from migraines are more likely to get headaches after a viral infection. Long Covid headaches may occur more frequently in patients who have suffered from primary headaches in the past.

Covid-19 can also cause a new, persistent headache that did not exist before Covid-19 illness, but continues for some time afterwards or is felt permanently. Most patients with Covid-19 report that their headaches improve within 2 weeks. However, for some it may take a few weeks longer or the headaches may persist chronically.

What do post-Covid-19 headaches look like?

The terms “post-Covid-19 headache” and “persistent headache post-Covid-19” are used both in clinical settings and in research. The terms describe all chronic headaches whose onset or worsening are temporally related to a confirmed SARS-CoV-2 infection.

  • One temporal pattern is the persistence of headaches occurring during the acute infection, despite the resolution of other symptoms of Covid-19. The frequency in various studies of headache during acute COVID-19 infection ranges from 13.0% to 74.6%. In 81.8% of patients, the headache begins with the onset of Covid-19 symptoms; it is usually bilateral frontal (34.0%-38.1%) or in the entire head (34.0%-38.8%) and presents mainly in the form of pressing pain (70.1%-73, 7%). More than half of patients report moderate or severe pain (60.6%-75.3%). Headache episodes often last longer than 24 hours, with almost half of patients reporting constant pain. In half of the cases, the pain follows a daily rhythm, usually worsening in the evening (24.2%). Pain is often worsened by exercise (12.37% - 45.5%) and cough. The headache is often accompanied by sensitivity to light (10.3%-29.3%) and sensitivity to noise (10.3%-27.3%).
  • The second pattern of persistent headaches after Covid-19 is characterized by the worsening and transition to a chronic course of pain in patients who had a migraine before COVID-19.
  • The third pattern is daily persistent headaches in patients with no personal history of primary headaches, where the pain begins after the acute Covid-19 has subsided and no headaches occurred during the acute infection itself.

Which mechanisms of Long Covid are being discussed?

The mechanisms underlying the acute SARS-CoV2 infection have been extensively investigated and identified. The exact reasons that lead to the persistence of symptoms and Long Covid are not yet known. The following formation mechanisms have been proposed:

  • Consequences of organ damage, extent of damage and time until recovery of the individual organ systems.
  • Persistence of chronic inflammation or formation of autoantibodies.
  • Persistence of the virus in the body in people with altered immunity, new infection or relapse.
  • Effects of hospitalization, complications related to the SARS-Cov-2 infection or complications related to comorbidities or adverse effects of the medications used.
  • Psychological consequences such as post-traumatic stress.
  • Social and financial impacts.

How is the diagnosis of Long Covid made?

The diagnosis of Long Covid is made based on the clinical symptoms and course. A multidisciplinary approach and multidisciplinary care are required. Risk factors that can lead to persistence of symptoms after an acute infection include older age, severity of the acute phase, obesity, female gender, comorbidities, asthma and more than five symptoms in the acute phase. But people without these risk factors can also develop Long Covid. The symptoms often overlap with the symptoms of other diseases. Long Covid is therefore diagnosed when the symptoms that occur have no other medical explanations.

How is Long Covid treated?

Long Covid and the type of symptoms require a multidisciplinary diagnostic assessment and complex interdisciplinary multimodal therapy. An interdisciplinary team must develop an individual therapy plan for each patient. The neurological and psychological aspects are an essential part of this. The team must include experts in the treatment of headaches, fatigue, respiratory diseases and other symptoms (shortness of breath, deconditioning, dizziness), in occupational therapy and physiotherapy and in clinical psychology.

Since the beginning of the pandemic, the team at the Kiel Pain Clinic has built up extensive experience with the diagnosis and treatment of Long Covid and has developed specialized therapy programs for it.
The focus is on headaches, other chronic pain, fatigue, memory problems, concentration problems and other neurological and psychological symptoms. Information about admission can be found here: https://krebsklinik.de/service-fuer-patienten/