Headache Associated With COVID-19

Epidemiology, Characteristics, Pathophysiology, and Management

Pedro Augusto Sampaio Rocha-Filho MD, PhD

Disclosures

Headache. 2022;62(6):650-656. 

In This Article

Epidemiology

Headache affects 47.1% (95% confidence interval [CI]: 35.8%–58.6%) of patients in the acute phase of COVID-19.[21] The frequency of headache varies according to the level of severity of the disease and is more frequent in outpatients than in hospitalized patients.[21] However, one cannot rule out the possibility that headaches were underreported by hospitalized patients.

The occurrence of headache is more frequent among younger people;[12,15,18,22] among those who have presented with previous primary headache[9,18,20] or previous migraine;[14,23] and those who have concomitantly presented with anosmia,[6,12,15,18] ageusia,[6,15,18] and myalgia[6,9,12] during the symptomatic phase of COVID-19. While some studies have reported that women have more headaches than men,[2,6,12,18,20,24] other studies have not.[13–15,17,22,25–27]

An association between fever and headache in COVID-19 has been reported by some[6,12,20] but not by all.[13,14,18,22,27] Although the presence of fever is considered important for the pathophysiology of headache associated with systemic viral infections,[28] to date, no studies have had the primary objective of assessing the association between headache and fever in COVID-19.

Controversy exists over whether headache is a good prognostic marker for patients with COVID-19. No association was observed between the presence of headache and the length of hospital stay in a case-control study conducted in Spain. However, those with headache had lower mortality than those without headache.[22]

In a Spanish retrospective cohort study, headache was associated with a lower mortality rate of patients hospitalized for COVID-19.[12] However, the presence of anosmia, which was associated with headache and the prognosis in other studies, was not controlled in the analysis.

No association was observed between the presence of headache and the length of hospital stay or mortality in a retrospective cohort study conducted in Brazil. This study aimed to assess whether neurological symptoms and complications were associated with the prognosis. Those with anosmia presented with a lower mortality rate and those with encephalopathy presented with a higher mortality rate.[29]

In a prospective cohort in Spain, patients with headache had a shorter illness compared to those without headache. There was no difference in mortality or length of hospital stay between those with or without headache.[18]

A prospective cohort study conducted in Iran that aimed to assess whether neurological symptoms were associated with the prognosis of COVID-19 reported that those with headache and those with anosmia presented with a less severe disease and a lower mortality rate.[25]

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