Persistent headache after COVID-19: Pathophysioloy, clinic and treatment

Membrilla, Javier A; Caronna, Edoardo; Trigo-López, Javier; González-Martínez, Alicia; Layos-Romero, Almudena; Pozo‐Rosich, Patricia; Ál, Guerrero-Peral; Gago-Veiga, Ana Beatriz; Andrés-López, A.; Terán, Javier Díaz de

doi:10.1016/j.neurop.2021.10.003

Cited by 12 publications

(17 citation statements)

References 47 publications

(45 reference statements)

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“…First, daily persistent long COVID headache bears significant similarities with one of the least understood headache types, NDPH [ 12 , 76 ]. Although NDPH is classified among the primary headache disorders [ 11 ], part of the cases occur in association with viral infections (especially EBV) [ 77 ].…”

Section: Future Directions and Outlooksmentioning

confidence: 99%

Long COVID headache

Tana

Bentivegna²,

Cho

et al. 2022

J Headache Pain

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Headache is among the most frequent symptoms persisting or newly developing after coronavirus disease 2019 (COVID-19) as part of the so-called long COVID syndrome. The knowledge on long COVID headache is still limited, however growing evidence is defining the features of this novel condition, in particular regarding clinical characteristics, some pathophysiological mechanisms and first treatment recommendations. Long COVID headache can present in the form of worsening of a preexisting primary headache, or, more specifically, in the form of a new (intermittent or daily) headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms, most frequently with hyposmia. It can manifest with a migrainous or, more frequently, with a tension-type-like phenotype. Persistent activation of the immune system and trigeminovascular activation are thought to play a role. As there are virtually no treatment studies, treatment currently is largely guided by the existing guidelines for primary headaches with the corresponding phenotype. The present report, a collaborative work of the international group of the Junior Editorial Board of The Journal of Headache and Pain aims to summarize the most recent evidence about long COVID headache and suggests approaches to the diagnosis and treatment of this disorder. Graphical Abstract

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Section: Future Directions and Outlooksmentioning

confidence: 99%

Long COVID headache

Tana

Bentivegna²,

Cho

et al. 2022

J Headache Pain

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“…For those with chronic lung disease, saturations in the 88 to 92% range may be acceptable Neurological • Patients should be evaluated for focal symptoms and sensory deficits • Unexplained muscle weakness may indicate the need for neurologic consult with electromyography and nerve conduction studies. Neurologic imaging is necessary only in the face of a neurologic deficit • Headache management includes amitriptyline, venlafaxine, and mirtazapine for tension-type headaches [ 40 ] • Migraine-like headaches may benefit from beta-blockers, neuromodulators, antidepressants, calcium channel blockers, or ACE inhibitors/angiotensin II receptor blockers [ 40 ] • Address mood, sleep, and stress disorders [ 40 ] Dysautonomia and orthostatic intolerance Patient education regarding physiologic changes associated with orthostatic intolerance syndrome, and management may provide reassurance [ 41 – 43 ]. This includes: • Structured non-upright exercise such as swimming, or recumbent exercise bicycle should be encouraged • Fluid and salt repletion with 2–3 L of water daily, one to two teaspoons of salt daily, and limiting alcohol and caffeine are recommended • Avoiding exacerbating factors such as prolonged standing, warm environments, dehydration, and sudden changes in position.…”

Section: Pasc and Managementmentioning

confidence: 99%

“…• Headache management includes amitriptyline, venlafaxine, and mirtazapine for tension-type headaches [ 40 ]…”

Section: Pasc and Managementmentioning

confidence: 99%

“…• Migraine-like headaches may benefit from beta-blockers, neuromodulators, antidepressants, calcium channel blockers, or ACE inhibitors/angiotensin II receptor blockers [ 40 ]…”

Section: Pasc and Managementmentioning

confidence: 99%

“…The true prevalence of post-COVID headache is unknown but is estimated to be 14–43% [ 103 ]. Medication overuse headaches, exacerbation of preexisting migraine headaches, and daily persistent headaches without prior headache history are potential etiologies [ 40 , 103 , 104 ]). COVID-associated headaches have been described as bifrontal, holocranial, frequently last for > 24 h, worse in the evening, exacerbated by exercise and coughing, associated with photophobia and phonophobia) [ 40 , 103 , 104 ].…”

Section: Pasc Symptoms That May Require Referral To Subspecialtiesmentioning

confidence: 99%

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Post-acute sequelae of COVID-19 (PASC): a meta-narrative review of pathophysiology, prevalence, and management

Seim

Dawson

Knight

et al. 2022

SN Compr. Clin. Med.

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Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Over 220 countries and territories have been affected by this virus, and the infection rate has continued to rise. As patients recover from the virus, many are experiencing lingering symptoms. Understanding the impact of demographics and comorbidities on symptom prevalence, manifestations, and severity is not only relevant during acute infection, it is critical to the clinical management of patients with post-acute sequelae of COVID-19, also known as PASC. Herein, we provide a comprehensive review on the most recent research related to PASC. Specifically, we focus on the description of the disorder itself, compared to acute COVID-19, and which types of patients are most affected by long-term sequelae. Further, we share recommendations for management of the most common complications of PASC.

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Post-COVID-19 neuropsychiatric manifestations among COVID-19 survivors suffering from migraine: a case–control study

et al. 2022

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Background The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group. Methods Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale. Results The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04–2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064–2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145–6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616–6.136, P-value = ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3–7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2–5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1–6). Conclusion The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms.

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Persistent headache after COVID-19: Pathophysioloy, clinic and treatment

Cited by 12 publications

References 47 publications

Long COVID headache

Long COVID headache

Post-acute sequelae of COVID-19 (PASC): a meta-narrative review of pathophysiology, prevalence, and management

Post-COVID-19 neuropsychiatric manifestations among COVID-19 survivors suffering from migraine: a case–control study

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