A rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata

Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Headache Characteristics of Patients with COVID-19 in Turkey: Is COVID-19 Infection a Trigger for Migraine Headache?

Introduction: Headache is a common symptom in patients with Coronavirus-19 infection (COVID-19). In this research, we aim to assess the frequency, characteristics, and response to treatment of headache in patients with COVID-19 and its correlation with psychosocial features in Turkey. Methods: To describe the clinical features of headache in COVID-19 positive individuals. Patients were evaluated and followed up with face-to-face visits in a tertiary hospital during the pandemic period. Results: One hundred and seventeen of 150 patients (78%) had a headache diagnosed before and during the pandemic, 62 of 150 (41.3%) had a new type of headache. No significant differences were observed in terms of demographics, Beck Depression Score, Beck Anxiety Score, and quality of life scales (QOLS) between patients with and without headache (p>0.05). The most common triggering factor for headache was stress and fatigue in 59% (n=69), while the second most common (32.4%, n=38) was COVID-19 infection. 46.5% of the patients reported that the severity and frequency of their current headaches increased after the COVID-19 infection. Among new-onset headaches, the social functionality and pain score subgroups of the QOLS form were significantly lower in housewives and unemployed patients compared to the working group (p=0.018; p=0.039 respectively). Twelve of 117 patients had a mild to moderate, throbbing headache in the temporoparietal region, which did not fulfill the International Classification of Headache Disorders diagnosis criteria, but showed as a common feature among COVID-19 patients. Nineteen of 62 patients (30.9%) had a newly diagnosed migraine syndrome. Conclusion: The diagnosis incidence of migraine in patients with COVID-19 disease being more than other headaches types may suggest the existence of a common pathway in possible immune mechanisms.

Acute and long-term neurological disorders in patients with coronavirus infection

Currently, patients who attribute their complaints and disorders to the past COVID-19 are turning to a neurologist for a consultation. One should consider dangerous complications of COVID-19 such as stroke, including cerebral venous thrombosis, autoimmune encephalitis and myelitis, posterior reversible encephalopathy syndrome, Guillain-Barre' syndrome. Disorders of consciousness, disorders of smell and taste, headache and dizziness are significantly more often present in the acute period of COVID-19. Long-term persistence of complaints and disorders after COVID-19 is regarded as post-COVID syndrome (PCS). Neurological complaints and disorders in a patient who has had COVID-19 are often caused by the development or exacerbation of a comorbid disease, including primary headache, musculoskeletal pain in the neck and back, various vestibular disorders, Alzheimer's disease, anxiety and depressive disorders. Unfortunately, in real clinical practice, these diseases are often not diagnosed, patients are observed with a diagnosis of PCS, and it is not taken into account that the basis for diagnosing PCS is the exclusion of other diseases that can explain complaints and disorders in a patient who has suffered from COVID-19.

NSAIDs medication for headache as the presenting symptom with migraine and COVID-19

Headache is one of the most prevalent disorders of the nervous system. Headache is also the most common symptom of a variety of diseases, including migraine, COVID-19. International Classification of Headache Disorders (ICHD) lists over a thousand different types of headaches. Migraine is a widely known type of primary headache. Much research supports that the enhancement in migraine intensity related to chronic migraine such as neurogenic neuroinflammation, possibly leading to increased cytokine expression via activation of protein kinases in neurons and glial cells of the trigeminovascular system like some of the other headache diseases. No currently drug class available, either specific (triptans, ergots) or non-specific (opioids, paracetamol, NSAIDs), is effective in all types of headaches, in all patients and all attacks of the same patient. However, non-steroidal anti-inflammatory drugs (NSAIDs) minimize prostaglandin synthesis by blocking cyclooxygenase, which is included in the pathophysiology of migraine headaches. We searched the employed source was The Journal of Headache and Pain database by using NSAIDs with Headache, Migraine, and COVID-19 keywords. The search was performed from April 2021 and included 2017-2018-2019-2020-2021 (last five years) the studies and reviews from the Journal of Headache and Face Pain Sites. Additionally, we noted the published or on-going studies, eight of these, about NSAIDs information contain searches that exist in the 12th European Headache Federation Congress (jointly with 32nd National Congress of the Italian Society) Study of Headaches’ book. Also, we included relationship migraine with COVID-19 studies to highlight the connection between the headache, which is one of the most common symptoms of both migraine and COVID-19, and the importance of managing migraine pain with NSAIDs during corona processing.

Primary headaches during the COVID-19 lockdown in Germany: analysis of data from 2325 patients using an electronic headache diary.

BACKGROUND: Lockdown measures due to the COVID-19 pandemic have led to lifestyle changes, which in turn may have an impact on the course of headache disorders. We aimed to assess changes in primary headache characteristics and lifestyle factors during the COVID-19 lockdown in Germany using digital documentation in the mobile application (app) M-sense. MAIN BODY: We analyzed data of smartphone users, who entered daily data in the app in the 28-day period before lockdown (baseline) and in the first 28 days of lockdown (observation period). This analysis included the change of monthly headache days (MHD) in the observation period compared to baseline. We also assessed changes in monthly migraine days (MMD), the use of acute medication, and pain intensity. In addition, we looked into the changes in sleep duration, sleep quality, energy level, mood, stress, and activity level. Outcomes were compared using paired t-tests. The analysis included data from 2325 app users. They reported 7.01 ± SD 5.64 MHD during baseline and 6.89 ± 5.47 MHD during lockdown without significant changes (p > 0.999). MMD, headache and migraine intensity neither showed any significant changes. Days with acute medication use were reduced from 4.50 ± 3.88 in the baseline to 4.27 ± 3.81 in the observation period (p < 0.001). The app users reported reduced stress levels, longer sleep duration, reduced activity levels, along with a better mood, and an improved energy level during the first lockdown month (p ≤ 0.001). In an extension analysis of users who continued to use M-sense every day for 3 months after initiation of lockdown, we compared the baseline and the subsequent months using repeated-measures ANOVA. In these 539 users, headache frequency did not change significantly neither (6.11 ± 5.10 MHD before lockdown vs. 6.07 ± 5.17 MHD in the third lockdown month, p = 0.688 in the ANOVA). Migraine frequency, headache and migraine intensity, and acute medication use were also not different during the entire observation period. CONCLUSION: Despite slight changes in factors that contribute to the generation of headache, COVID-19-related lockdown measures did not seem to be associated with primary headache frequency and intensity over the course of 3 months.

Headache teleconsultation in the era of COVID-19: Patients' evaluation and future directions.

BACKGROUND AND PURPOSE: Literature regarding headache teleconsultation and patient satisfaction is scarce. The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity by adopting telemedicine. Our objectives were to evaluate patients' satisfaction with headache teleconsultation by telephone during the SARS-CoV-2 pandemic and assess patients' preferred model of appointment (face-to-face, teleconsultation by telephone, or both). METHODS: Patients with a previous diagnosis of primary headache or neuropathies and facial pain disorders, and at least one telephone headache visit during the first wave of COVID-19, filled out an online questionnaire regarding sociodemographic parameters, satisfaction with teleconsultation, and preferred model of appointment. RESULTS: We included 83 patients (valid response rate of 64.3%); most had migraine (83.1%). Regarding teleconsultation, 81.9% considered this model adequate for follow-up, 88.0% were satisfied with the information provided about the disease/treatment, and 73.5% were satisfied with the medication modification. Ninety percent would agree with a new tele-evaluation if stable after the pandemic. The mixed model was the preferred medical consultation type for the postpandemic period (43.4%), followed by face-to-face visits (33.7%). CONCLUSIONS: Patients were satisfied with the headache teleconsultation during the COVID-19 era. However, an exclusive model of telemedicine does not seem suitable for monitoring all patients. A mixed approach could be integrated into clinical practice after the pandemic to optimize health care.

Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study.

OBJECTIVE: To study the characteristics of headache attributed to COVID-19 infection and predictors of its severity. METHODS: A cross-sectional study involved 172 individuals who had headache due to COVID-19 infection. A detailed analysis of such headache was done through a face-to-face interview. Patients with any other form of secondary headache were excluded. Labs, including lymphocytic count, C-reactive protein, D-dimer and ferritin and chest imaging, were made available. RESULTS: THE: majority of our patients had a diffuse headache (52.9%). It was pressing in 40.7%, with median intensity of 7 (assessed by visual analogue scale) and median frequency of 7 days/week. Patients with preexisting primary headache (52.9%) had significantly more frequent COVID-19 related headache than those without (47.1%) (p = 0.001). Dehydrated patients (64.5%) had more frequent COVID-19 related headache than those who were not dehydrated (35.5%) (p = 0.029). Patients with fever (69.8%) had significantly higher frequency and intensity of COVID-19 related headache compared to those without fever (30.2%) (p = 0.003, 0.012). Patients with comorbidities (19.8%) had significantly higher frequency and intensity of headache than those without comorbidities (80.2%) (p = 0.006, 0.003). After multiple linear regression, primary headache disorders, dehydration and comorbidities were considered predictors of frequency of COVID-19 related headache. Meanwhile, fever and dehydration were predictors of pain intensity. CONCLUSION: Healthcare providers of COVID-19 patients need to be aware of frequency and intensity predictors of COVID-19 related headache: Primary headache disorders, fever, dehydration, and comorbidities.

Relative Frequency and Risk Factors of COVID-19 Related Headache in a Sample of Egyptian Population: A Hospital-Based Study.

OBJECTIVES: Headache is considered one of the most frequent neurological manifestations of coronavirus disease 2019 (COVID-19). This work aimed to identify the relative frequency of COVID-19-related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. DESIGN: Cross-sectional study. SETTING: Recovered COVID-19 patients. SUBJECTS: In total, 782 patients with a confirmed diagnosis of COVID-19 infection. METHODS: Clinical, laboratory, and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. RESULTS: The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% confidence interval (CI) (.516-.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. DISCUSSION: Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.