The Emergence of a New Form of Headache in COVID-19 Pandemic Era

Abstract

BackgroundHeadache is the most common COVID-19-related neurological symptom. But, diagnostic clues of headache for COVID-19 infection are not well known. MethodsWe developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. Findings 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21±11.2 years experiencing headache during pandemic contributed to the survey. Among them, 262 participants had COVID-19 and 126(48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p<0.000). COVID-19 related headaches were more closely associated with anosmia/ageusia and gastrointestinal complaints (RR=3.7 and RR=1.33, respectively), showed different characteristics like pulsating, pressing, and even stabbing quality. Logistic regression analyses showed that bilateral headache, duration over 72 hours, analgesic resistance and having male gender were significant variables to differentiate COVID-19 positive patients from those without COVID-19 (p<0.000 for all variables). A worsening of previous primary headaches due to the pandemic-related problems was not the rule in majority of patients.Interpretation Bilateral, long-lasting headaches, resistance to analgesics and having male gender were more frequent in people with COVID-19 in conjunction with the anosmia/ageusia and gastrointestinal complaints. These features may be helpful for COVID-19 diagnosis in the clinical evaluation of headache patients during the pandemic.Funding: This study was funded by Scientific Research Projects Coordination Unit of Istanbul University with a project number of GAP-36802.

Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6

“…The disease was defined first with fever, myalgia/exhaustion cough, dyspnea, and involvement the lower respiratory system. Neurotropic and neuroinvasive features of SARS-CoV-2 were also detected in humans with various neurological symptoms including headache, dizziness, smell, and taste impairments [1][2][3]. Other symptoms related to gastrointestinal distress, loss of appetite, and weight loss were also defined during the pandemic [4,5].…”

“…Headache symptom was present in approximately 12% in COVID-19 patients, according to a meta-analysis including more than 40,000 patients from 60 studies [6]. Majority of clinical studies generally presented headache rate in their cohort, which was greatly variable depending on the disease severity, recruiting inpatients including ICU or outpatients, obtaining data from hospital records or self-reports/questionnaires [2][3][4][5][6][7].…”

“…Detailed information about headache features associated with COVID-19 was reported in several studies [3,[7][8][9]. Headache was reported to occur early in the course of the illness and could manifest as an isolated symptom of the disease or presenting symptom of COVID-19 preceding cough or fever [3,7,8].…”

“…Detailed information about headache features associated with COVID-19 was reported in several studies [3,[7][8][9]. Headache was reported to occur early in the course of the illness and could manifest as an isolated symptom of the disease or presenting symptom of COVID-19 preceding cough or fever [3,7,8]. Headache associated with COVID-19 was described as moderate to severe, unrelenting, new-onset, bilateral, frontal pain, and worsening with movements [3,[7][8][9].…”

“…Headache was reported to occur early in the course of the illness and could manifest as an isolated symptom of the disease or presenting symptom of COVID-19 preceding cough or fever [3,7,8]. Headache associated with COVID-19 was described as moderate to severe, unrelenting, new-onset, bilateral, frontal pain, and worsening with movements [3,[7][8][9]. Headache in COVID-19 may be manifestation with migraine-like sensory disturbances such as photophobia, phonohobia, osmophobia, and/or atypical symptoms such as anosmia, or diarrhea, loss of appetite, and weight loss [3,7,8].…”