Headache Associated With COVID-19

Epidemiology, Characteristics, Pathophysiology, and Management

Pedro Augusto Sampaio Rocha-Filho MD, PhD


Headache. 2022;62(6):650-656. 

In This Article

The Characteristics of Headache in the Acute Phase of COVID-19

Headache usually begins early in the symptomatic phase of COVID-19, [12,14,16,17,20,30] starting on the first day of illness in 39% to 55%,[6,9,12,15,16,19] and is the first symptom in 6% to 29% of patients (generally around 25%).[6,12,14,16–20,31] In some patients, headache may be the only symptom of COVID-19.[32]

For 47% to 80% of those with previous headache, the COVID-19 headache is described as being different from the previous pattern.[6,14,15,17,22,33] In general, the pain has an insidious onset,[17] is bilateral,[1,14–16,19,27,31] is of a moderate to strong intensity,[6,14–16,18–20,27,31] and presents a pressing or tightening quality.[14,16,18,19,27,30,31] Pain may be associated with photophobia (in 14% to 49%),[6,14–16,19,27,30] phonophobia (in 5% to 41%),[14–16,19,27,30] and nausea and/or vomiting (in 14% to 43%).[6,15,16,18,19,27,30] The most frequent pattern reported by most studies was a tension-type headache phenotype.[6,9,19,20,27] However, other studies have reported a migraine phenotype.[15,25,34] All studies found the migraine pattern and the tension-type headache pattern as frequent phenotypes.[6,9,15,18–20,25,27,34]

The headache presented by patients admitted during the symptomatic phase of COVID-19 in a Spanish hospital met the criteria of the International Headache Society for headache attributed to systemic viral infection in 94.3% of cases.[19]

Although cough has been reported as a frequent symptom of COVID-19, a few studies have assessed the cough headache pattern (headache triggered by cough). These studies observed a frequency of 2%,[25] 10%[14] and 16%.[15]

Patients cite coughing (33% to 43%),[14,19] physical activity (10% to 53%),[14,15,18,19] moving the head (31%),[19] moving the eyes (19%),[19] and bending (7%)[19] as factors that aggravated the headache.