Abstract and Introduction
Objective: To 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.
Background: Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease.
Method: This 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.
Results: Half 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.
Conclusions: Headache 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.
Neurological symptoms are frequent in coronavirus disease 2019 (COVID-19), the disease caused by the coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and affect 9% to 92% of hospitalized patients. This difference in frequencies is due to methodological differences between studies (e.g., data collection through patient interviews vs. a review of medical records) and patients with different disease severity included in them.[1–6] Although respiratory symptoms generally dominate the clinical aspects of the disease, 22% of patients with moderately severe COVID-19, who do not need to be admitted to the intensive care unit, report that neurological symptoms trouble them the most. The most frequent neurological symptoms of the disease are headache, anosmia, ageusia, and myalgia.[1–3,6–10]
During the first half of 2020, studies that assessed the symptoms of COVID-19 considered headache an infrequent, minor symptom that affected 10% of patients. Over time, studies have demonstrated a much higher frequency of headache and that headache may be a significant clinical problem in the treatment of these patients.[6,12–20] For 14% to 19% of patients who present with headache, this is the symptom that most troubles them.[6,16,19]
The aim of this article is to review the epidemiology, characteristics, secondary headache associated with complications of COVID-19, pathophysiology, and management of headache associated with COVID-19. The persistence of headache after the acute phase of COVID-19 was also reviewed.
Headache. 2022;62(6):650-656. © 2022 Blackwell Publishing