Objective.-To summarize available literature regarding headache as a manifestation of coronaviruses and to describe potential underlying mechanisms. Review Methods.-References for this review were identified by searches within PubMed without any date restrictions. The search terms used were coronavirus disease 2019 (COVID-19) clinical manifestation, COVID-19 epidemiology, neurologic findings in COVID-19, headache in COVID-19, neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and headache in SARS-CoV-2. Results.-Headache is one of the most common neurologic complaints in patients with SARS-CoV-2. While the pathophysiological connection between headache and SARS-CoV-2 is unclear, inflammatory mechanisms may play a key role. One of the mechanisms cited in the literature of migraine and other headache disorders is the activation of nociceptive sensory neurons by cytokines and chemokines. A similar mechanism has been reported in SARS-CoV-2 with the release of cytokines and chemokines by macrophages throughout the course of infection. Other mechanisms for headache in SARS-CoV-2 include (1) viral neuroinvasion as seen with viral encephalitis; (2) hypoxemia due to the well-described pulmonary manifestations of the disease; and (3) thrombosis secondary to COVID-19 induced hypercoagulable states. Conclusion.-According to the Centers for Disease Control, common symptoms of human coronavirus include fever, cough, runny nose, sore throat, and headache. In the case of SARS-CoV-2, there are limited reports about headaches, one of the most common clinical manifestations. There are currently no studies that focus specifically on headache among patients with SARS-CoV-2 infection.

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ObjectivesTo report two different presentations of migraine with the olfactory hallucinations. A case with the typical hallucinatory olfactory symptoms preceding migraine headaches and another case with longstanding olfactory hallucinations.BackgroundMigraine prevails in about 12% of the general population, with the migraine aura accountable for at least one-third of these cases. The most common aura is the visual aura, followed by the sensory aura, speech, and motor auras. Olfactory hallucinations preceding the headache phase of migraine are rare. To date, the International Classification of Headache Disorders (ICHD) has not recognized them as a subset of migraine aura.ResultsThis report presents a patient with a typical Phantosmia (PO) aura before her migraine headache and a patient who experiences a longstanding PO aura.ConclusionThe olfactory hallucination may present differently in patients with migraine disease. Based on the clinical significance of migraine with olfactory hallucinations, we propose that the ICHD classify this phenomenon as a subtype of aura in the future. However, larger studies are still required to better assess the pathophysiology of this phenomenon.

Objectives: The objective of this case report is to discuss botulinum toxin as a treatment for Red Ear Syndrome (RES) and refractory chronic migraine, as well as provide a brief overview of possible RES etiologies. Background: Because RES presents with several conditions, its pathophysiology and treatment options are difficult to define. Given their similar clinical presentations, RES may be an auricular subtype of erythromelalgia. Additionally, RES presents consistently with chronic migraine. Botulinum toxin has been proven an effective medication for erythromelalgia and refractory migraine, and it may be just as useful for RES. Results: This paper reports one case of a patient who presented with chronic migraine with aura and unilateral RES. This patient failed several treatment options, and the most recent regimen only reduced the intensity of migraine attacks. With the addition of botulinum toxin, both chronic migraine and RES symptoms were mitigated. Conclusion: While a definitive treatment for RES has not been determined, a promising option for patients with concomitant chronic migraine may be botulinum toxin.

Objectives: To report a case with post-surgical intracranial hypotension and inconclusive diagnostic findings. Background: The diagnosis of spontaneous intracranial hypotension is based on positive neuroimaging findings and/or low CSF pressure on spinal tap. Despite this conventional definition, cases with normal CSF pressure have also been reported. Results: This report explains a patient with post-surgical CSF leak, normal CSF opening pressure, and unremarkable imaging studies that responded well to the surgical repair. Conclusion: Our case challenges the conventional diagnostic criteria of spontaneous intracranial hypotension. We suggest that clinical judgment should be considered in regard to the diagnosis of spontaneous intracranial hypotension.