Stellate Ganglion Block for Refractory Post-COVID Headache: Case Report

Long coronavirus disease (COVID) is a multitude of symptoms weeks to months after recovering from COVID 2019 (COVID-19) and involves a variety of symptoms, ranging from brain fog and fatigue to refractory headaches that may result in ongoing disability.

A 49-year-old man presents for persistent headaches following COVID-19 infection months prior. The pain was frontal and bilateral but more prominent on the right, without sensitivity to light nor sound, and without identifiable triggers. He trialed numerous medications without relief. He rated his pain on average 8-10 on the Visual Analog Scale (VAS). After discussion of options, the patient elected to proceed with a stellate ganglion block (SGB). The patient underwent a right-sided SGB with 5 mL of 0.25% bupivacaine. Following the injection, the patient noted ~50% benefit immediately. On 6-week follow-up, he noted improvement of his headaches to 1-2 on the VAS. At 4 months, the headaches continued to be controlled (1-2 on the VAS).

Reports suggest that symptoms from long COVID are caused by dysregulation of the sympathetic nervous system. We report the use of the SGB for treating refractory headaches related to long COVID, suggesting that the SGB may relieve the dysautonomia.