Previous History of Migraine Is Associated With Fatigue, but Not Headache, as Long-Term Post-COVID Symptom After Severe Acute Respiratory SARS-CoV-2 Infection: A Case-Control Study

Abstract

ObjectiveTo investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the presence of post-coronavirus disease (COVID) symptoms.BackgroundNo study has investigated the role of migraine as a risk factor for development of post-COVID symptoms.MethodsA case-control study including individuals hospitalised during the first wave of the pandemic (from February 20 to May 31, 2020) was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed.ResultsOverall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months (SD 0.6) after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater (OR 1.70, 95% CI 1.29–2.25, P < 0.001) than in the non-migraine group. Fatigue was significantly more prevalent (OR 2.89, 95% CI 1.32–6.32, P = 0.008) in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected.ConclusionPatients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms.

Headache as a COVID‐19 onset symptom and post‐COVID‐19 symptom in hospitalized COVID‐19 survivors infected with the Wuhan, Alpha, or Delta SARS‐CoV‐2 variants

“…An important finding was that the presence of headache as a COVID‐19 onset symptom but not a history of migraine before the infection was associated with development of post‐COVID‐19 headache in patients infected with the Wuhan or Delta variants, in agreement with some studies. 5 , 16 Accordingly, monitoring headache at the acute phase of SARS‐CoV‐2 infection may alert clinicians of a systemic inflammatory response and potential development of post‐COVID‐19 headache. Interestingly, no difference in the clinical pattern of headache among the three SARS‐CoV‐2 variants was found, because it consistently took on features similar to migraine or tension‐type headache, as previously described.…”

Long COVID headache

“…In that sample, prior history of migraine was also associated with post-COVID headache (OR: 2.90; 95% CI: 1.41–5.98) [ 25 , 26 ]. These data have been previously explored in a smaller sample from the same cohort, that evaluated 57 patients with confirmed diagnosis of migraine prior to the COVID infection and 144 age-and-sex matched controls, where no significant differences were observed regarding anxiety or depression during long COVID evaluated with the Hospital Anxiety and Depression Scale (HADS), but with a higher frequency of post-COVID symptoms (OR: 1.50; 95% CI: 1.09–2.09) [ 27 ]. Another case–control study observed that patients with prior history of migraine had 40% more frequent long-lasting headache, as defined by continuous headache present for more than 1 day [ 28 ].…”

Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management

“…In another study, which assessed patients who had been discharged from the hospital after a mean period of 7 months, the diagnosis of previous migraine was not associated with the persistence of headache. 52 However, previous primary headaches may become worse after COVID‐19. 23 , 34 …”