Protracted headache after COVID-19: A case series of 31 patients from a tertiary headache center.

Abstract

BackgroundHeadache can be a prominent feature of Post‐Acute Sequelae of SARS‐Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection.MethodsWe performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID‐19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis.ResultsHeadache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD‐3) criteria for migraine, with 20/31 (65%) meeting ICHD‐3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full‐time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches.ConclusionsOur study presents a group of patients with protracted headache after COVID‐19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD‐3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.