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Curr Pain Headache Rep ; 25(11): 73, 2021 Nov 11.
Article in English | MEDLINE | ID: covidwho-1527506

ABSTRACT

PURPOSE OF REVIEW: Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. RECENT FINDINGS: The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.


Subject(s)
COVID-19/epidemiology , Headache/epidemiology , Anosmia/physiopathology , COVID-19/complications , COVID-19/mortality , COVID-19/physiopathology , Endothelium, Vascular , Headache/etiology , Headache/physiopathology , Headache/therapy , Humans , Inflammation , Migraine Disorders/physiopathology , SARS-CoV-2 , Tension-Type Headache/physiopathology , Trigeminal Ganglion/physiopathology , Trigeminal Ganglion/virology , Trigeminal Nerve/physiopathology , Trigeminal Nerve/virology , Viral Tropism
2.
Mol Neurobiol ; 58(9): 4487-4494, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1242821

ABSTRACT

Headache is the most common neurological symptom in COVID-19, reported in 6.5 to 34% of patients. Few studies have analyzed its characteristics, and some of them included cases without laboratory confirmation or reported only critical patients. We aimed to analyze the clinical characteristics of COVID-19 associated headache in laboratory-confirmed cases. We conducted a retrospective evaluation of patients with COVID-19 and neurological symptoms. Patients who reported headache answered an interview about its clinical characteristics. Twenty-four patients with COVID-19 associated headache completed the interview. Mean age of patients was 53.8 (standard deviation-17.44), and 14 out of 24 (58.3%) were male. The majority (75%) had no previous history of headache. Fever was documented in 19 out of the 24 patients (79.1%). Headache was predominantly bifrontal or holocranial, in pressure, during hours, worsening with cough or physical activity. COVID-19 headache tends to appear in the first days of symptoms, be either frontal or holocranial and last for days. The quality of pain in pressure and the worsening with cough or physical activity were reported in most cases. We have not found any characteristic that could differentiate COVID-19 associated headache from other causes of headache, possibly because of its multifactorial mechanism.


Subject(s)
COVID-19/complications , Headache/etiology , SARS-CoV-2 , Adolescent , Adult , Antihypertensive Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Comorbidity , Cytokines/physiology , Endothelium, Vascular/physiopathology , Endothelium, Vascular/virology , Female , Fever/etiology , Headache/physiopathology , Humans , Inflammation , Male , Models, Biological , Neoplasms/epidemiology , Retrospective Studies , Symptom Assessment , Trigeminal Nerve/virology , Young Adult
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