Abstract
ObjectiveTo define headache characteristics and evolution in relation to COVID-19 and its inflammatory response.MethodsThis is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution.ResultsOf 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010).ConclusionsHeadache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.
Highlights
The global pandemic caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is putting our healthcare systems at stake
As studies related to headache associated with viral infections are lacking, and COVID-19 is clearly associated with headache, we decided to define and describe headache characteristics and evolution in relation to COVID-19, focusing on it as a possible prognostic factor
Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 duration
Summary
The global pandemic caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is putting our healthcare systems at stake. COVID-19 is the infectious disease caused by this viral pathogen, and which can lead, in some patients, to respiratory failure amongst other severe symptoms, requiring urgent medical aid. COVID-19 gives the opportunity to define its headache characteristics, which until now have mainly been described in terms of prevalence, with discrepant results, the prevalence in studies based on clinical charts review in China (8–23%) [5,6,7,8] or Spain (14.1%) [9] being substantially different from interview-based cross-sectional study (70%) [10]. As studies related to headache associated with viral infections are lacking, and COVID-19 is clearly associated with headache, we decided to define and describe headache characteristics and evolution in relation to COVID-19, focusing on it as a possible prognostic factor. We decided to correlate the presence of headache with systemic inflammatory responses and hypothesise about its pathophysiological mechanisms
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