Understanding Neurological Manifestations in Long COVID: Svetlana Blitshteyn, MD, FAAN


The director of Dysautonomia Clinic discussed neurological manifestations of Long COVID, such as headache, cognitive complaints, and sleep problems, and how they are similar to those seen with migraine comorbidities. [WATCH TIME: 5 minutes]

WATCH TIME: 5 minutes

"The brain is not separate from the body. If [a patient] has a systemic disorder, [they] will have neurologic manifestations."

After the initial surge of infections from the COVID-19 pandemic, the clinical focus has shifted to management of the long-term symptoms of the illness. Post-acute COVID, known as Long COVID, has become an emerging prevalent syndrome in the previously infected patient population. The condition is identified by weakening symptoms that can last for weeks or more following mild illness. According to recent research, Long COVID may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes.1 Thus, researchers have recommended that clinicians be equipped to recognize such cases to reduce symptom burden and provide supportive management.

Dysautonomia, characterized by autonomic nervous system dysfunction, includes a wide range of disorders with the most common being postural orthostatic tachycardia syndrome, neurocardiogenic syncope, and orthostatic hypotension.2 In a recent published review, findings revealed a significant overlap and shared pathophysiology in migraine and dysautonomia disorders in studies.1 Conducted by author Svetlana Blitshteyn, MD, FAAN, director and founder of Dysautonomia Clinic, she noted that diagnosis and treatment of these disorders in patients with migraine is important for comprehensive patient-centric care, reduce symptom burden, and improve functional impairment secondary to both migraine and comorbidities.

Blitshteyn, who also serves as a clinical associate professor of neurology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, recently sat down in an interview NeurologyLive® to have discuss commonly seen neurological manifestations in both patients with migraine comorbidities and those with Long COVID. She also talked about how the onset of headache after the age of 50 years relates to potential secondary causes like Long COVID. In addition, Blitshteyn spoke about pre-existing conditions that increase the risk of developing Long COVID, and how they intersect with migraine comorbidities and allergies.

1. Dani M, Dirksen A, Taraborrelli P, et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond). 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896
2. Blitshteyn S. Dysautonomia, Hypermobility Spectrum Disorders and Mast Cell Activation Syndrome as Migraine Comorbidities. Curr Neurol Neurosci Rep. 2023;23(11):769-776. doi:10.1007/s11910-023-01307-w
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