One of the most common types of headaches is infection-related headache. This condition occurs as a result of flu, common cold, sinusitis, or different infections developing in our body. It is seen more frequently especially in winter months and can make daily life difficult.

Infection-related headache is generally a temporary condition. When the underlying infection is treated or when the body overcomes the infection, the headache also disappears spontaneously. However, correct diagnosis and follow-up are important because it can sometimes be a symptom of more serious diseases.

While our body is fighting infection, the immune system secretes certain chemical substances (for example, cytokines and prostaglandins – that is, defense substances related to inflammation). These substances lead to fever elevation and inflammation, while also triggering headache. The characteristics of headache may vary according to the type of infection (virus, bacteria, fungus, etc.), its severity, and the organ where it is located.

What is Infection-Related Headache?

Infection-related headache is a headache accompanying infections developing in any part of the body. Unlike migraine or tension-type headache, this type of pain has an underlying cause: the infection itself.

Symptoms generally appear as follows:

• Headache together with fever,
• Weakness and fatigue,
• Accompanying complaints such as nasal discharge, cough, or sore throat,
• Findings specific to the organ where the infection is located (for example, facial and forehead pain in sinusitis, burning in urinary tract infection, neck stiffness in meningitis).

The severity of headache varies according to the location of infection:

• Generally mild in conditions like simple common cold,
• Can be much more severe in infections affecting the brain and nervous system.

As the infection is treated or as the immune system defeats the infection, the headache also decreases.

What Causes Infection-Related Headache?

Infection-related headache can have many different causes. The most commonly encountered situation is inflammation and fever that emerge while the body is fighting infection. Substances secreted during this process affect brain vessels and nerves, leading to headache.

1. Viral Infections

These are the most common causes. They are seen frequently especially in winter months.

• Viruses such as influenza, common cold (rhinovirus), adenovirus, and parainfluenza lead to headache together with fever, weakness, and muscle pain.
• COVID-19 infection can also trigger headache very frequently and sometimes severely.

2. Bacterial Infections

Can cause more serious headaches.

• Acute sinusitis: Causes headache together with pressure sensation in facial and forehead region.
• Headache is frequently seen in situations such as throat infection (beta/streptococcus), ear infection, dental abscess, pneumonia.
• Generally accompanied by high fever and pain in the region where the infection is located.

3. Nervous System Infections (Emergency Situations)

These are the most dangerous causes and require emergency treatment:

• Meningitis (inflammation of brain membranes): Severe, unbearable headache; generally accompanied by fever and neck stiffness.
• Encephalitis (brain inflammation): Viral in origin and progresses with headache, fever, and altered consciousness.
• Brain abscess: Develops when bacteria create inflammation in brain tissue and causes localized, intense headache.

4. Other Infections

• Systemic infections: Headache is frequently seen in diseases affecting the entire body such as typhoid, malaria, tuberculosis.
• Parasitic and tick-borne infections: Headache is also an important symptom in some infections such as Lyme disease.

What are the Symptoms of Infection-Related Headache?

The characteristics of infection-related headache may vary according to the type of infection. However, some common symptoms are seen in most patients.

General Characteristics

• Headache generally starts together with fever and infection symptoms.
• Pain is mostly sudden onset and felt widespread throughout the head, in a pressing manner.
• Headache increases as fever rises, when fever drops, pain decreases.

Frequently Seen Accompanying Symptoms

• Weakness, fatigue, and general exhaustion,
• Muscle and joint pains,
• Loss of appetite, sometimes nausea,
• Sweating and shivering attacks,
• Sleep irregularity, restlessness.

Symptoms According to Type of Infection

• Respiratory tract infections (flu, cold): Cough, nasal discharge, sore throat.
• Sinusitis: Pain in facial and forehead region, nasal congestion, headache increasing with bending forward.
• Ear infection: Ear pain, hearing decrease.
• Dental infections: Headache together with jaw and tooth pain.

Alarm Symptoms in Serious Infections

If the following findings emerge, this situation requires emergency medical intervention:

• Neck stiffness,
• Excessive sensitivity to light (photophobia),
• Confusion or tendency to sleep,
• Persistent vomiting,
• High fever (39°C and above),
• Vision impairments, double vision,
• Seizures.

Infection-related headache is mostly temporary, but if the above serious symptoms are present, a doctor should be consulted without delay.

International Classification of Headache Disorders (ICHD-3) Diagnostic Criteria – 9.2 Headache Attributed to Infection

This group covers headaches developing secondary to systemic, intracranial, or local infections.

Headache appears during the active period of infection and generally disappears after the infection resolves.

ICHD-3 divides these headaches into subgroups according to the location and type of agent:

9.1 Headache Attributed to Intracranial Infection

9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis

1. There is a diagnosis of bacterial meningitis or meningoencephalitis.
   B. Headache appears in temporal relationship with the onset of infection.
   C. Headache is present while infection is active and disappears or significantly decreases when infection is treated.
   D. Headache cannot be explained by another diagnosis.

Note: Pain is generally diffuse, throbbing, continuous in character and accompanied by meningeal symptoms such as fever, neck stiffness, altered consciousness, nausea, vomiting.

9.1.2 Headache attributed to viral meningitis or encephalitis

Defined similarly, but generally milder and more prolonged in course.

9.2 Headache Attributed to Systemic Infection

This group includes headaches seen during infections in other parts of the body (for example, flu, COVID-19, bacteremia, pneumonia, etc.).

1. There is a defined systemic infection (bacterial, viral, fungal, or parasitic).
   B. Headache appears in temporal relationship with the onset of infection.
   C. Headache increases or decreases in parallel with the course of infection.
   D. Headache disappears after complete resolution of infection.
   E. Cannot be explained by another cause.

Clinical Features:

• Generally diffuse, dull, pressing-type pain.
• Accompanied by systemic symptoms such as fever, muscle pain, fatigue, loss of appetite.
• Its severity may progress in parallel with fever elevation or cytokine release.

9.3 Headache attributed to local infections of the head or neck

Seen in conditions such as sinusitis, mastoiditis, dental abscess, or otitis media.

1. There is a defined local infection.
   B. Headache is anatomically consistent with the region where infection is located.
   C. Appears in the same period as the onset of infection.
   D. When infection is treated, headache disappears.
   E. There is no other cause.

Clinical Features:

• Pain is generally localized (for example, forehead, cheek, or around eyes in sinusitis).
• Increases with bending forward, accompanied by fullness or pressure sensation.
• There are symptoms such as fever, nasal congestion, purulent discharge.

ICHD-3 General Diagnostic Principles

For a headache to be considered infection-related:

1. Temporal relationship (starting or worsening together with infection),
2. Clinically or laboratory-confirmed presence of infection,
3. Regression of headache after infection resolves are mandatory.

How is Infection-Related Headache Diagnosed?

For diagnosis of infection-related headache, both the characteristics of headache and the underlying infection are investigated. The diagnostic process progresses in several steps:

1. History (Patient’s Account)

The doctor first asks about the headache:

• When it started,
• How long it lasted,
• Its severity and form,
• Whether there are additional symptoms such as fever, cough, nasal discharge, sore throat, diarrhea.
  Recently experienced diseases, travel history, vaccinations, and medications used are also evaluated.

2. Physical Examination

• Temperature measurement is performed.
• Sinusitis or throat infection is investigated with ear, nose, and throat examination.
• Pneumonia findings are checked by listening to lungs.
• Suspicion of meningitis or serious brain infection is evaluated with neurological examination. Neck stiffness is an important finding at this point.

3. Laboratory Tests

• Blood tests: If white blood cells are elevated, infection probability increases.
• Inflammation tests (CRP, sedimentation): Support presence of infection.
• Culture tests: Bacteria can be detected with blood, throat, or urine culture.
• Virus tests (PCR): Used in diagnosis of viral diseases such as flu, COVID-19.

4. Imaging Methods

• Sinus tomography (CT): In case of sinusitis suspicion,
• Chest X-ray: In case of pneumonia suspicion,
• Brain MRI/CT: Can be used in case of brain infection suspicion.

5. Special Diagnostic Methods

• Lumbar puncture (spinal tap): Gold standard method in case of meningitis suspicion. With this test, cerebrospinal fluid is examined and the type of infection is confirmed.

The most important point in diagnosing infection-related headache is that the headache progresses in parallel with infection symptoms. If headache increases with fever and decreases when fever drops, this type of headache is suspected.

Infection-Related Headache Treatment

1. In Viral Infections (Flu, Cold, etc.)

Most viral diseases heal spontaneously. Therefore, supportive treatment is in the foreground:

• Rest and plenty of sleep,
• Daily high fluid consumption (2-3 liters),
• Fever-reducing and pain-relieving medications (paracetamol, ibuprofen),
• Light and nutritious foods,
• Relaxing methods (warm shower, light massage, relaxation exercises).

Aspirin is not recommended in children because it can lead to a serious complication called Reye syndrome.

2. In Bacterial Infections (Sinusitis, Throat Inflammation, etc.)

In this case, antibiotic treatment is necessary. Which antibiotic to use varies according to the location and microbe of the infection. Your doctor will choose the most suitable antibiotic for you.

3. In Serious Infections (Meningitis, Encephalitis, Sepsis)

These diseases require emergency intervention and generally need to be treated in hospital.

• Intravenous antibiotic or antiviral medications,
• Intensive care follow-up,
• Supportive treatments (fluid therapy, oxygen, fever control).

4. Supportive Measures

• Bed rest,
• Regular fluid intake,
• Balanced nutrition,
• Stress reduction,
• Steam or hot compress applications if there is nasal congestion.

5. Preventive Measures

The best way to prevent infection-related headache is to prevent infections:

• Paying attention to hand hygiene,
• Using masks in crowded and closed environments,
• Adhering to vaccination programs (for example, flu vaccine),
• Adopting healthy lifestyle habits that strengthen the immune system.

6. Prognosis

• Viral infections generally heal within 7-10 days.
• Bacterial infections are brought under control within 3-7 days with appropriate antibiotic.
• In serious infections, prognosis depends on early diagnosis and treatment.

The triad of fever, headache, and weakness is the most typical finding of infection-related headache. However, if headache is accompanied by neck stiffness, confusion, or vision impairment, a doctor should be consulted urgently.

Frequently Asked Questions About Infection-Related Headache

1. How Can I Distinguish Infection-Related Headache from Normal Headache?

The most important difference of infection-related headache is that it is seen together with fever and infection symptoms. While there is no fever in migraine or tension-type headache, in infection headache there is generally fever of 38°C and above.

• Onset: Infection headache starts suddenly, progresses together with symptoms such as weakness, muscle pain, shivering, sore throat.
• Character: Diffuse pain surrounding the entire head, pressing, dull-type pain is typical. Pain increases as fever rises, decreases when fever drops.
• Additional symptoms: Focus findings are seen such as nasal congestion in sinusitis, difficulty swallowing in throat infection, ear pain in ear infection.
  In normal headaches, this parallel course and accompanying infection findings are not found.

2. How Long Does Infection-Related Headache Last? Does It Go Away Spontaneously?

Duration varies according to the type of infection:

• Viral infections (flu, common cold): Decreases within 3-7 days, headache in COVID-19 can last up to 10-14 days.
• Bacterial infections (sinusitis, throat infection): Relief occurs within 24-48 hours after starting antibiotic, disappears in 5-7 days.
• Untreated bacterial infections: Can worsen and headache intensifies.

In short, infection headache generally does not go away spontaneously, the underlying infection needs to be treated. In viral infections, rest, plenty of fluids, and fever reducers are sufficient. If symptoms prolong or worsen, a doctor must be consulted.

3. Which Infections Cause Infection-Related Headache? Is This Condition Serious?

• Viral infections: Respiratory tract infections such as flu, cold, COVID-19 are the most common causes.
• Bacterial infections: Sinusitis, throat infection, ear infection, dental abscess, pneumonia cause headache. Requires antibiotic but most are not severe.
• Serious infections: Meningitis (inflammation of brain membranes), encephalitis (brain inflammation), brain abscess, sepsis (blood poisoning) can be life-threatening and cause very severe headache.
• Systemic infections: Headache is also frequently seen in infections affecting the entire body such as malaria, typhoid, tuberculosis, Lyme disease.

If fever exceeds 39°C, or if there are findings such as neck stiffness, confusion, persistent vomiting, vision impairment, this condition is serious and requires emergency intervention.

4. When Should I See a Doctor for Infection-Related Headache?

Situations requiring immediate doctor consultation:

• Fever above 39°C and severe headache,
• Headache together with neck stiffness, excessive sensitivity to light, confusion, seizure,
• Persistent vomiting, double vision, or vision loss,
• Headache together with skin rash.

Under normal circumstances, doctor control is also needed in the following situations:

• If headache and fever don’t pass within 48-72 hours,
• If there is no improvement within 2-3 days despite starting antibiotic,
• If general condition is worsening or new complaints are being added.

In risk groups (children, elderly, those with chronic diseases, immunocompromised individuals, pregnant women), earlier doctor consultation is recommended.

5. What Can I Do at Home for Infection-Related Headache?

Supportive treatments that can be applied at home are as follows:

• Rest and sleep: Take care to sleep 8-10 hours per day.
• High fluid intake: Consume 2-3 liters of water, herbal tea, or freshly squeezed fruit juices.
• Fever and pain control: Paracetamol or ibuprofen can be used (with doctor recommendation).
• Nutrition: Consume light, easily digestible, and vitamin-rich foods (soup, yogurt, fresh fruit).
• Relaxing methods: Warm shower, hot compress on forehead and temples, light massage can be beneficial.
• Quiet and dark environment: Especially if there is light sensitivity, keeping the environment dim is comforting.

However, if there is suspicion of bacterial infection (yellow-green phlegm, ear discharge, intense sore throat, etc.), a doctor must be consulted and antibiotic treatment should be started. Because this type of headache only completely improves when the infection is treated.