Headache Frequency and Quality of Life in Patients with Post-Acute Sequelae of COVID-19

ABSTRACT

Objective: We sought to describe PASC-related headache severity and quality of life in a cohort of non-hospitalized individuals presenting to our outpatient neurology practices (PASC) Background: People with post-acute sequelae of COVID-19 (PASC) have reported many neurological symptoms such as brain fog, memory difficulties, and headache. Design/Methods: Participants with evidence of prior COVID-19 infection were asked to complete symptom scales, Neuro-QOL (anxiety, depression, and fatigue), and validated headache questionnaires Headache Impact Test-6 and American Migraine Prevalence and Prevention questionnaire. Results: Among 98 participants reporting PASC symptoms after acute illness, mean age was 50.5±15.1 and 65% were female. Headache (49%) was the second most frequent neurologic symptom reported after fatigue (67%). 18% (18/98) had a prior history of migraine headaches. 38.9% (7/18) of participants with pre-morbid migraine reported more than 15 symptomatic headache days per month. When controlling for age and sex, there was a statistically significant difference (p=0.011) between in participants with a prior migraine history indicating more frequent headaches in the last 3 months (mean 39.0±28.5 headaches) compared to participants without prior migraine (mean 18.5±25.3 headaches). HIT-6 scores were also significantly greater (p=0.005) in participants with a migraine history after adjusting for age and sex, (58.6±13.2) versus 47±12.2) indicating worse quality of life related to headaches. In participants with HIT-6 scrores>=56 indicating substantial or severe impact on quality of life and AMPP scores meeting criteria for chronic migraine, NeuroQOL scores for depression, anxiety, and fatigue were also elevated/worse. Conclusions: People with PASC in a neurology outpatient practice, with a prior migraine history report elevated headache frequency, worse quality of life related to their headaches as indicated by the HIT-6 test and Neuro-QOL. These data support the inclusion of headache specific measures in studies of PASC in larger samples and suggests that COVID-19 infection can impact headaches.