Patterns of COVID-19-related headache: A cross-sectional study

Abstract

Background: Headache is the most common COVID-19-related neurological symptom. We investigated the characteristics of COVID-19-related headache and their relationship with clinical severity in Kırşehir Province, Turkey.

Methods: This cross-sectional study prospectively enrolled 226 COVID-19-positive patients who developed headache during acute infection. Demographic data, headache characteristics, and infection symptoms were recorded. The clinical severity of COVID-19 was documented in each participant.

Result: New-onset COVID-19-related headaches lasting 4 days were reported in 164 patients (72.5 %); these were mostly bilaterally or localized to the forehead (58.4 %), pulsating (42.5 %), moderate to severe intensity (30.1 %), with a partial response to paracetamol (23.5 %). The other 62 patients (27.4 %) reported headaches before COVID-19. Their COVID-related headaches were fiery type (p = 0.025), of very severe intensity (p = 0.008), had a holocranial distribution (p = 0.004), and were less response to paracetamol (p = 0.003); the headaches were significantly more frequent after COVID-19 than before COVID-19. Older age, high body mass index, and low education level were significantly higher in the severe group (all p < 0.001). Female sex (p = 0.019) and being a healthcare worker (p < 0.001) were significantly more frequent in mild cases.

Conclusions: Bilateral, prolonged, moderate to severe headaches that were analgesic resistant are more frequent in patients with COVID-19 infection. Further study should examine whether the headache characteristics distinguish COVID-19-related headaches from other types, particularly in asymptomatic subjects.

Keywords: COVID-19; Headache; Neuroinvasion; Neurological manifestations; SARS-CoV-2 virus.