Cognitive impairments (brain fog, concentration-, attention issues, memory loss) and headaches

Foggy, dry, or cloudy thinking that could be stress or Long Covid, often described as brain fog.

Cognitive impairment: Patients often report difficulty concentrating, processing information, as well as attention problems, cognitive issues and difficulty in maintaining everyday life functions. These symptoms are debilitating and can have an adverse impact on patients, especially those who are professionally active or still studying. 

Headache: Frequent or persistent headaches, chronic debilitating headaches that are not improving or migraines. Long Covid headaches are generally previously undiagnosed tension headaches, migraines or manifestations of PESE.  

Sources:  
Post-Covid recommendations for primary care physicians – Switzerland  
Practical management of post-Covid19 disease, Dr Ioannis Kokkinakis, Dr Mathieu Saubade, Dr Konstantinos Tzartzas, Dr Serge De Vallière, Dr Catherine Duquenne, Pr Gilles Allali, Dr Frédéric Regamey and Pr Bernard Favrat - Rev Med Suisse 2023 

  •  

    • Mental fatigue 

    • Feeling mentally "fuzzy" 

    • Inability to think clearly 

    • Loss of thread of ideas (short term memory failures) 

    • Spacing out 

    • Trouble concentrating 

    • Difficulty to make things done 

  • Simple actions to begin, that you can do right now:  

    • Use a notebook to plan all the tasks of the day, even the most trivial ones  

    • Alternate easy and difficult tasks 

    • Schedule the most difficult tasks at the best time of day (when you have the most energy) 

    • Take care of your sleep-wake cycle (wake up and go to sleep at the same hour any day of week, event during the week-end) 

    • No alcohol or drugs that can affect your brains need for sleep 

    • Keep time for resting but don’t nap longer than 15 to 20 minutes  

    • Rest means minimal activity and little or no mental stimulation like TV or social media 

    • Use memory aids like a to do list to remember what you have to do and write information you have to remember to try not to forget 

    • Avoid multitasking 

    • If possible, calm environment without noise 

    Additional actions to go further:

    • Mindfulness meditation

    • Breathing exercises (potentially in a dark room) 

    • Keep a headache diary 

    • Paced exercise 

    • Do yoga, stretching, craniosacral therapy to reactivate your nervous system 

    • Walks in nature (forest bathing) 

    • Take the time to appreciate beautiful things around you (sunset for instance) 

    • Eliminate mental stimulation like earphones and looking at your smartphone 

    • Light memory games 

  • Cognitive impairment:

    • History and physical examination including neurobehavioral assessment 

    • Blood test 

    Headache:

    • History and physical examination including neurological assessment. 

    • Rule out secondary causes of headache 

    • Symptomatic treatment  

    • Riboflavin (vitamin B2) high dose 400 mg 1 ×/day for at least 3 months (specific treatment for headache caused by long covid) 

    • Magnesium 300 mg 1x/day

    • Cervical manual medicine 

    Tests:

    • Montreal Cognitive Assessment (MOCA) 

    • Brain MRI 

    • Neuro- psychological assessment 

    • Cognitive and functional assessment

  • Neuropsychological therapy:  

    • Symptom management 

    • Cognitive pacing 

    • Neuro visual rehabilitation (neurotrack) 

    • Cognitive training 

Find out what has worked for others experiencing your symptoms.

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