Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study

Abstract

Introduction: Headache is one of the most frequent neurologic manifestations in COVID-19. We aimed to analyze which symptoms and laboratory abnormalities were associated with the presence of headache and to evaluate if patients with headache had a higher adjusted in-hospital risk of mortality. Methods: Retrospective cohort study. We included all consecutive patients admitted to the Hospital with confirmed SARS-CoV-2 infection between March 8th and April 11th, 2020. We collected demographic data, clinical variables and laboratory abnormalities. We used multivariate regression analysis. Results: During the study period, 576 patients were included, aged 67.2 (SD: 14.7), and 250/576 (43.3%) being female. Presence of headache was described by 137 (23.7%) patients. The all-cause in-hospital mortality rate was 127/576 (20.0%). In the multivariate analysis, patients with headache had a lower risk of mortality (OR: 0.39, 95% CI: 0.17-0.88, p = 0.007). After adjusting for multiple comparisons in a multivariate analysis, variables that were independently associated with a higher odds of having headache in COVID-19 patients were anosmia, myalgia, female sex and fever; variables that were associated with a lower odds of having headache were younger age, lower score on modified Rankin scale, and, regarding laboratory variables on admission, increased C-reactive protein, abnormal platelet values, lymphopenia and increased D-dimer. Conclusion: Headache is a frequent symptom in COVID-19 patients and its presence is an independent predictor of lower risk of mortality in COVID-19 hospitalized patients.

Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia

“…Patients with these complaints presented a significantly higher frequency of headache and these symptoms had a close temporal relationship, mostly occurring at the beginning of the symptomatic phase of COVID-19. Another study also found a higher frequency of headaches amongst those who had anosmia (20). Most neurological symptoms are likely to occur in the early stages of the disease with a median of 1–2 days, as cited in a recent review (18).…”

“…Three studies that assessed neurological symptoms in patients admitted with COVID-19 reported higher frequencies of headache (27% (10), 39% (19) and 43% (9)). A retrospective cohort study that assessed the prognostic value of headache concerning mortality found a headache frequency of 24% (20). One European multicenter study that assessed symptoms of patients hospitalized with COVID-19 reported a frequency of headache similar to that of the present study (70%) (21).…”

Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis

“…In total, 78 studies were included to calculate the prevalence of headache in COVID-19 and all studies were published in 2020. The studies were conducted in Brazil 50 , China 13,51-96 , Egypt 97 , France 98-101 , Germany 102 , India 103,104 , Italy [105][106][107][108][109][110][111] , Japan 112,113 , Jordan 114 , Somalia 115 , South Korea 116,117 , Spain 118,119 , Turkey 120,121 , and the US [122][123][124][125][126] . Two studies were cross-sectional 119,122 , five were prospective cohort studies 65,90,98,110,121 and the remaining 71 studies were retrospective studies.…”

Prevalence of Headache in Patients With Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of 14,275 Patients

“…It can appear as the first symptom in meningeal involvement in these cases. Presence of headache was linked to other central nervous system (CNS) manifestations in patients with COVID-19, suggesting that it is also a CNS-associated infectious disease (13). Headache in patients with COVID-19 does not seem to have any particular characteristics, as it is described as tension-type headache or migraine without aura (14)-the two most frequently observed types of headache (12), or a migraine-like headache type (15,16).…”