There is more that can be done for Long COVID patients right now than most clinical settings reflect. The evidence exists — the challenge is organizing it into a usable framework.
Fatigue, brain fog, dyspnea, chest pain, and dizziness are among the most commonly reported Long COVID symptoms — and among the least specific for guiding treatment decisions.
These complaints frequently represent the downstream effects of multiple distinct, treatable sub-syndromes. When the workup is organized around the symptom rather than the underlying syndrome, the result is often a series of inconclusive specialist referrals — not because nothing is wrong, but because the search is aimed at the wrong target. A sub-syndrome framework offers a more productive starting point.
Because Long COVID–specific placebo-controlled trials remain scarce, the clinical framework borrows systematically from adjacent evidence bases: ME/CFS, dysautonomia, migraine, fibromyalgia, and chronic pain medicine — all conditions with robust trial literature that applies directly.
POTS profile; NASA Lean Test; hydration-first sequencing before pharmacotherapy
Migraine as sensory processing disorder — nearly universal; often present without headache
Distinct from classic mastocytosis; histamine triggers; H1/H2 blockade first-line
Five distinct entities; CBT-I first; orexin antagonists; sodium oxybate in hypersomnia
Three-part framework; crash differentiation by type; avoid graded exercise before stabilization
In practice, medications in Long COVID are often less effective — or less tolerable — when the foundational pillars haven't been optimized first. The sequencing matters, and it's worth addressing early.
100–300 oz water/day, 3–8g sodium, mid-thigh compression — before POTS medications. Inadequate volume makes most autonomic agents intolerable.
Slow elimination protocol for migraine and MCAS triggers. Mediterranean framework as baseline. Caution: high rates of prior disordered eating in this population.
Sleep optimization may be the highest-yield universal intervention. CBT-I before hypnotics. Distinguish insomnia, non-restorative sleep, hypersomnia, and circadian dysregulation.
Pacing, psychotherapy, and motivational interviewing adapted for medically traumatized patients. Physical therapy sequenced after autonomic stabilization — not before.
This is the most common missed diagnosis in Long COVID. Patients with photophobia, phonophobia, motion sensitivity, and nausea — but no headache — are migraineurs. The entire migraine pharmacopeia is available to them. Most providers never reach for it.
The evidence base for migraine prevention and abortive therapy is among the most robust in neurology. It applies directly to this population.
Evidence-grounded content distilled from ME/CFS, autonomic medicine, migraine, and chronic pain literature — with clinical applicability as the primary lens.
The three-lever framework: water volume, sodium supplementation, and physical compression — and why sequencing generally matters before starting pharmacotherapy.
Read → Assessment ToolOffice-based orthostatic intolerance quantification. Three key metrics: resting HR, orthostatic increment, peak HR. No tilt table required.
Read → Treatment EvidenceControlled trial data supporting consideration of one of the more underutilized interventions — with a plausible mechanism and a well-established safety profile.
Read → PEM / CrashesOrthostatic, migrainous, and true post-exertional crashes often respond to different interventions. Distinguishing them tends to change management substantially.
Read → Sleep MedicineFive distinct entities: insomnia, non-restorative sleep, circadian dysregulation, hypersomnia, and sleep-disordered breathing — each worth evaluating separately.
Read →A 17-chapter clinical guide accepted for publication. Covers the complete sub-syndrome framework, evidence-based pharmacotherapy sequences, case vignettes, and the Four Pillars in detail.
Dr. Claunch works collaboratively — the goal is never to displace a patient's primary team, but to provide the sub-syndrome assessment and treatment framework, then return them with a clear, actionable plan.
Refer a patient for evaluation. A written clinical summary — sub-syndrome targets, treatment sequence, medication rationale — is returned to you after each assessment.
Submit a Referral →For PCPs and specialists who expect to refer multiple patients. Establishes a direct communication line, streamlined referral processing, and periodic clinical updates.
Become a Partner →Questions about the clinical framework, the PCP book, CME or speaking opportunities, research collaboration, or anything else.
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