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Headache ; 61(8): 1277-1280, 2021 09.
Article in English | MEDLINE | ID: covidwho-1345953


One year after the outbreak of coronavirus disease 2019 (COVID-19), referrals for persistent headache, often defined as "post-COVID headache," have become increasingly common in outpatient headache clinics. However, it is important to take into consideration that this term may include a spectrum of clinically different headache types. We describe three cases of migraine-like headaches in individuals with a history of mild COVID-19 infection to demonstrate some of the different phenotypes of persistent headaches seen. These cases highlight the importance of a careful evaluation when assessing the complexities of "post-COVID headache" as well as the need to further investigate the different, underlying, pathophysiological mechanisms.

COVID-19/complications , Migraine Disorders/virology , Adult , Female , Humans , Male , Middle Aged , SARS-CoV-2
Cephalalgia ; 40(13): 1410-1421, 2020 11.
Article in English | MEDLINE | ID: covidwho-1088416


OBJECTIVE: To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. METHODS: This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. RESULTS: Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). CONCLUSIONS: Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.

Coronavirus Infections/complications , Headache/virology , Pneumonia, Viral/complications , Adult , Aged , Betacoronavirus , Biomarkers/blood , COVID-19 , Coronavirus Infections/immunology , Female , Headache/epidemiology , Humans , Inflammation/blood , Inflammation/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/immunology , Prodromal Symptoms , Prospective Studies , SARS-CoV-2