Headache Associated With COVID-19

Epidemiology, Characteristics, Pathophysiology, and Management

Pedro Augusto Sampaio Rocha-Filho MD, PhD

Disclosures

Headache. 2022;62(6):650-656. 

In This Article

Abstract and Introduction

Abstract

Objective: To review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID-19–associated headache. The persistence of headache after the acute phase of COVID-19 was also reviewed.

Background: Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease.

Method: This is a narrative review. A literature review was conducted in the PubMed database with the following terms: "headache" and "COVID-19." All articles written in English that were considered relevant were included.

Results: Half of the patients who have COVID-19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension-type headache. All studies found the migraine pattern and the tension-type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti-inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID-19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients' headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID-19 may trigger new daily persistent headache.

Conclusions: Headache is a clinically significant symptom of COVID-19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.

Introduction

Neurological symptoms are frequent in coronavirus disease 2019 (COVID-19), the disease caused by the coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and affect 9% to 92% of hospitalized patients. This difference in frequencies is due to methodological differences between studies (e.g., data collection through patient interviews vs. a review of medical records) and patients with different disease severity included in them.[1–6] Although respiratory symptoms generally dominate the clinical aspects of the disease, 22% of patients with moderately severe COVID-19, who do not need to be admitted to the intensive care unit, report that neurological symptoms trouble them the most.[6] The most frequent neurological symptoms of the disease are headache, anosmia, ageusia, and myalgia.[1–3,6–10]

During the first half of 2020, studies that assessed the symptoms of COVID-19 considered headache an infrequent, minor symptom that affected 10% of patients.[11] Over time, studies have demonstrated a much higher frequency of headache and that headache may be a significant clinical problem in the treatment of these patients.[6,12–20] For 14% to 19% of patients who present with headache, this is the symptom that most troubles them.[6,16,19]

The aim of this article is to review the epidemiology, characteristics, secondary headache associated with complications of COVID-19, pathophysiology, and management of headache associated with COVID-19. The persistence of headache after the acute phase of COVID-19 was also reviewed.

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