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

Abstract

ObjectiveTo review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID‐19–associated headache. The persistence of headache after the acute phase of COVID‐19 was also reviewed.BackgroundHeadache is a frequent symptom of COVID‐19, and understanding its management is important for health‐care professionals involved in treating the disease.MethodThis is a narrative review. A literature review was conducted in the PubMed database with the following terms: “headache” and “COVID‐19.” All articles written in English that were considered relevant were included.ResultsHalf of the patients who have COVID‐19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension‐type headache. All studies found the migraine pattern and the tension‐type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti‐inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID‐19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients’ headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID‐19 may trigger new daily persistent headache.ConclusionsHeadache is a clinically significant symptom of COVID‐19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.