Headache characteristics in COVID-19 pandemic-a survey study

DOI: https://doi.org/10.1186/s10194- 020- 01188- 1

Abstract-Summary Headache is the most common COVID-19-related neurological symptom.

The participants were grouped according to being diagnosed with COVID-19

infection or not, and having previous or new-onset headaches.

The COVID-19 related headache features and their associations with other clini-

cal features were investigated.

A binary logistic regression model was performed to differentiate the character-

istics of headache related to COVID-19.

COVID-19 related headaches were more closely associated with anosmia/ageu- sia and gastrointestinal complaints (p < 0.000 and p < 0.000), and showed different characteristics like pulsating, pressing, and even stabbing quality.

Logistic regression analyses showed that bilateral headache, duration over 72 h, analgesic resistance and having male gender were significant variables to differenti- ate COVID-19 positive patients from those without COVID-19 (p = 0.04 for long duration and p < 0.000 for others).

Bilateral, long-lasting headaches, resistance to analgesics and having male gen- der were more frequent in people with COVID-19  in conjunction with anosmia/ ageusia and gastrointestinal complaints.

These features may be helpful for diagnosing the headache related to COVID-19

during the pandemic.

Extended: The participants were invited by means of social media (using Twitter, Instagram or Whatsapp) using a web-based link, suitable also for smart phones, after the Ethics Committee approval (17.04.2020/520).

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COVID-19 and SARS-COV2 Vaccines

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A binary logistic regression model was performed to explore the differentiating

headache variables between COVID-19 positive and negative cases.

Introduction A handful of reports disclosed that headache is among the COVID-19-related symp- toms, showing highly variable rates across the studies [263–266].

In clinical observations and small case series, COVID-19 related headache was described as acute at onset, usually occurring in a different character unlike previ- ous headaches [246, 267].

Another important problem is the situation of patients with previous severe head-

aches like migraine in the COVID-19 pandemic era.

We aimed to reveal COVID-19 related headache characteristics and its

associations.

Our secondary aims were to investigate the features and course of pre-existing headaches as well as new-onset ones in participants without COVID-19 but having headaches during the pandemic.

Methods Even if the patient was not diagnosed with COVID-19, factors secondary to the pandemic lifestyle as possible triggers of headache, such as wearing a mask, having the fear of infection, etc. were evaluated.

The questionnaire has included a total of 39 questions, and based on four differ- ent parts, in terms of demographics, previous headache features, reported COVID-19 infection features, and details of the headache course after the pandemic.

Discharged COVID-19 patients of the Istanbul University Faculty of Medicine Hospital were invited by text messages to volunteer the survey, in order to increase the number of patients with COVID-19 infection-related headache.

Eligible participants older than 18-years who had a COVID-19 infection experi- encing headache among their symptoms or who had any type of headache before the pandemic, or developed new-onset headaches were included.

Although reaching a high number in a few hours, the survey was continued to the

end of this period to include more patients with COVID-19 related headaches.

Results Headaches lasting over 72 h were reported by 10.3% (27 out of 262 participants) of COVID-19 infected patients versus 4.1% (130 out of 3196 participants) of the COVID-19 negative group (p < 0.000).

The great majority of COVID-19 patients with previous headaches (79.5%, 89 out of 112 responders) reported that their new emerging headaches during the infec- tion period were different from their usual headaches; among them, 50% (56 par- ticipants) disclosed that this new headache was totally different, whereas 29.5% (33 participants) reported some differences despite some similar properties resembling previous headache features.

Severity of the previous headaches did not relate to receiving COVID-19 diagno- sis; COVID-19 positive patients had reported headaches of mild intensity in 26.6% (34 out of 128 responders), moderate-intensity in 47.7% (61 participants), severe in 23.4% and very severe (dependent to bed/hospital) in 2.3% (3 participants).

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5 Future Directions

Discussion This first careful analysis of emerging headache characteristics in the pandemic showed that COVID-19 related headaches are more closely associated with anos- mia/ageusia and gastrointestinal complaints, in comparison to other usual infection findings.

Despite the well-known predominance of headaches in females and the fact that more than 2/3 of participants answering our survey consisted of females, COVID-19 related headaches were reported by male patients at a high rate.

Most of the patients with pre-existing headaches easily noticed that this was a different problem if they had COVID-19 related headache according to our survey.

In a recent case report, the authors highlighted the need to consider secondary headaches, related to central nervous system infections in the setting of COVID-19 in patients experiencing refractory headache, even if the patient had chronic migraine [268].

Conclusion The COVID-19 pandemic seems to have a particular effect on the characteristics and the course of headaches in individuals with and without COVID-19 diagnosis, according to our findings.

We disclosed that having male gender, bilateral, long-lasting headaches, and resistance to analgesics were more frequently seen in people with COVID-19 infec- tion in conjunction with anosmia/ageusia and gastrointestinal complaints, besides other infection findings.

We propose that these features may be diagnostic for COVID-19 infection in the

clinical evaluation of headache patients during the pandemic.

Acknowledgement A machine generated summary based on the work of Uygun, Özge; Ertaş, Mustafa; Ekizoğlu, Esme; Bolay, Hayrunnisa; Özge, Aynur; Kocasoy Orhan, Elif; Çağatay, Arif Atahan; Baykan, Betül 2020 in The Journal of Headache and Pain.

Chronic migraine in the first COVID-19 lockdown: the impact of sleep, remote working, and other life/psychological changes