Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis

Abstract

Background: This study was conducted to determine the prevalence of headache in coronavirus disease 2019 (COVID-19) and to assess its association as a predictor for COVID-19. This study also aimed to discuss the possible pathogenesis of headache in COVID-19. Methods: Available articles from PubMed, Scopus, and Web of Science were searched as of September 2nd, 2020. Data on characteristics of the study, headache and COVID-19 were extracted following the PRISMA guidelines. Biases were assessed using the Newcastle-Ottawa scale. The cumulative prevalence of headache was calculated for the general population (i.e. adults and children). The pooled odd ratio (OR) with 95% confidence intervals (95%CI) was calculated using the Z test to assess the association between headache and the presence of COVID-19 cases. Results: We included 104,751 COVID-19 cases from 78 eligible studies to calculate the global prevalence of headache in COVID-19 and 17 studies were included to calculate the association of headache and COVID-19. The cumulative prevalence of headache in COVID-19 was 25.2% (26,464 out of 104,751 cases). Headache was found to be more prevalent, approximately by two-fold, in COVID-19 patients than in non-COVID-19 patients with symptoms of other respiratory viral infections, OR: 1.73; 95% CI: 1.94, 2.5 with p=0.04. Conclusion: Headache is common among COVID-19 patients and seems to be more common in COVID-19 patients compared to those with the non-COVID-19 viral infection. No definitive mechanisms on how headache emerges in COVID-19 patients but several possible hypotheses have been proposed. However, extensive studies are warranted to elucidate the mechanisms. PROSPERO registration: CRD42020210332 (28/09/2020)

Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience

“…These studies are based in samples of patients with moderate severity of COVID-19. However, in severe COVID-19 patients the headache frequency reported was about 27.83%, including 309 COVID-19 cases from 15 studies ( Mutiawati et al, 2020 ). Surprisingly, in relation with this symptom it was also indicated that the duration of the clinical symptoms of COVID-19 in patients with headache is shorter (23.9 ± 11.6 days) than in infected patients without headache (31.2 ± 12.0 days), being significant ( p = 0.028) and suggesting that the headache could be an alarm sign, to protect the body against the virus through the activation of the immune system ( Caronna et al, 2020 ).…”

Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences

“…Headache is a common symptom in viral infections. It has been reported in COVID-19 patients with a high prevalence (Mutiawati et al 2020). However, several characteristics of headache might differ in COVID-19 patients.…”

Headache in Post-COVID-19 Patients: Its Characteristics and Relationship with the Quality of Life

“…Headache is one of the main neurological symptoms of SARS-CoV-2 infection, and is almost two times more prevalent in COVID-19 patients than other respiratory viral infections [ 38 ]. A previous study showed that the global prevalence of headache in COVID-19 was 25.2% (26,464 out of 104,751 cases) [ 39 ]. Headache was the first reported symptom of COVID-19 in 42.2% (84/199), with prolonged headache persisting in 13.6% (27/199), and of those, more than 10.2% (20/199) lasted for more than 3 months [ 38 ].…”