Head and neck manual lymphatic drainage for self-reported neurocognitive symptoms in post-COVID condition: a proof-of-concept cohort study

Objective Neurocognitive symptoms, such as brain fog, difficulty concentration, sleep disturbances, and headaches, are among the most common and hardest-to-treat symptoms of post-COVID syndrome (PCC) and have been linked to blood-brain barrier disruption and impaired glymphatic clearance. Cerebrospinal fluid drains into cervical lymph nodes, an efflux enhanced by head and neck lymphatic manipulation. This proof-of-concept study investigated whether manual lymphatic drainage (MLD) of the head and neck region is associated with a change in neurocognitive symptom burden in 49 patients with PCC. Headache, brain fog, concentration, and sleep were assessed before and after treatment on a 100-mm visual analog scale, life satisfaction (primary endpoint), fatigue, and a subjective efficacy rating were additional endpoints. Results Life satisfaction remained unchanged (SWLS − 0.2, P = 0.738). All four symptoms decreased significantly (brain fog − 15.6 mm; concentration − 13.5 mm; headache − 11.3 mm; sleep − 8.2 mm; all P ≤ 0.014), as did fatigue (FSS − 0.6, P = 0.006). In this uncontrolled, single-arm design, these changes cannot be distinguished from spontaneous remission, regression to the mean, or expectation effects. Nevertheless, MLD of the head and neck region was associated with an improvement in self-reported neurocognitive symptoms, the findings generate new hypotheses and warrant randomized controlled trials