Abstract
Clinical publications show consistently that headache is a common symptom in the coronavirus disease of 2019 (COVID-19). Several studies specifically investigated headache symptomatology and associated features in patients with COVID-19. The headache is frequently debilitating with manifold characters including migraine-like characteristics. Studies suggested that COVID-19 patients with headache vs. those without headache are more likely to have anosmia. We present a pathophysiological hypothesis which may explain this phenomenon, discuss current hypotheses about how the coronavirus SARS-CoV-2 enters the central nervous system and suggest that activation of the trigeminal nerve may contribute to both headache and anosmia in COVID-19.
Highlights
Clinical publications show consistently that headache is a common symptom in the coronavirus disease of 2019 (COVID-19)
The trigeminal nerve, has been suggested by Caronna et al [5] and Bolay et al [8] to be as likely to serve as a point of entry into the brain and if so, could explain the loss of taste and smell and the headache associated with an infection of SARS-CoV-2 (Figure 1)
Another receptor that binds SARS-CoV-2, the neuropilin-1 receptor (NRP1), which is expressed in olfactory neurons, has recently been suggested as an alternative way to enter the neurons [16]
Summary
Clinical publications show consistently that headache is a common symptom in the coronavirus disease of 2019 (COVID-19). Meinhardt and colleagues [6] presented postmortem findings in patients with COVID-19 and discussed how SARS-CoV-2 enters the central nervous system (CNS) and causes multiple neurological symptoms including headache and loss of smell and taste. The olfactory neuroepithelium shows a high expression of ACE2 receptors used by SARS-CoV-2 to enter the cells, which has been suggested to cause the early olfactory dysfunctions [7].
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