Spectrum of Headaches Associated With SARS‐CoV‐2 Infection: Study of Healthcare Professionals

Abstract

Background Series of patients with SARS‐CoV‐2 infection report headache in 6%‐15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No study published to date has analyzed the characteristics of headache in these patients. Objective To analyze the characteristics of COVID‐19 related headaches. Methods We conducted a survey of Spaniard healthcare professionals who have been infected by SARS‐CoV‐2 and presented headache during the course of the disease. The survey addressed respondents’ medical history and headache characteristics, and we analyzed the association between both. Results We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension‐type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013). Conclusion Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID‐19.

Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study

“…We propose that the impact of headache in COVID-19 prognosis should be studied in deeper detail. Compared with other symptoms, headache might have different phenotypes and each presentation might have a different meaning [39,40]. We hypothesize that the impact of headache on prognosis might be linked to the causes of headache [41].…”

Neurological Aspects of SARS-CoV-2 Infection: Mechanisms and Manifestations

“…Two recent systematic reviews and meta-analyses showed that headache and dizziness are among the most frequent neurological symptoms affecting COVID-19 patients (71,72). Interestingly, headache can occur even in the absence of fever and can be manifested as a migraine, tension-type, or cluster headache (73).…”

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

“…In general, three main primary headaches are observed in COVID-19 patients i.e. migraine, cluster headache and tension-type headache [137][138][139][140] . No fixed mechanisms have been reported on how these headaches emerge in COVID-19 patients.…”

“…In regards to the headache characteristics presented by COVID-19 patients compared to the headache induced by other viral infections, no apparent differences could be observed. Headache in COVID-19 could be worsened by physical or head movement, felt in either the entire head (holocranial) or unilaterally (hemicranial) and and the pain is typically pressing or tightening 139 . It is hypothesized that headaches occurring in COVID-19 patients might be the result of the same mechanisms as observed in influenza A and influenza B infections, which could be related to the activity of cytokines 173,[185][186][187] .…”