DEAR DR. ROACH: Is there anything a person can do to make it less likely that a COVID infection leads to long COVID symptoms? Does activity help or harm a person in this case?

–L.B.

ANSWER: Before getting COVID in the first place, being vaccinated helps prevent a COVID infection, and even if you get infected, it probably reduces the likelihood that a person will suffer long-term symptoms, often called “long COVID.” Once a person is infected, early treatment with Paxlovid improves symptoms, but a randomized trial did not show a significant benefit in it reducing the risk of long COVID symptoms.

Activity has not been shown to help or worsen the likelihood of developing long COVID. In general, I recommend exercising as tolerated after a serious infection like influenza or COVID, neither pushing yourself to do more nor forcing yourself to stay in bed.

DEAR DR. ROACH: I am an 84-year-old male who is very active and in good health. On a recent visit to my ophthalmologist, I described to him what I had been experiencing for the past year or so: a sensation like looking through a kaleidoscope primarily in my left eye, which lasts anywhere from a couple minutes to maybe 15 minutes.

There is no pain, and it doesn’t hinder my ability to see somewhat clearly. The ophthalmologist said, “Oh, you are having silent migraines,” and he did not seem worried about it. When I went to my geriatric doctor, he suggested that I see a neurologist to make sure nothing else is going on. What can you tell me about silent migraines?

— D.P.

ANSWER: Migraine aura without headaches, also called an acephalic migraine, a migraine equivalent, and a silent migraine, is when a person gets the aura of a migraine without the headache. It’s not that uncommon; I see this condition in my patients who are usually over 50.

The visual changes experienced vary from person to person. There may be flashing lights or zigzag lines. Some people see geometric shapes. These symptoms last for less than an hour and are usually in both eyes. When there are “positive” findings like zigzag lines or lights, the diagnosis isn’t really in doubt.

New onset headaches at age 84 is still uncommon, so I tend to agree with your geriatrician that a visit to a neurologist would be worthwhile.

ToYourGoodHealth@med.cornell.edu.

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