Long COVID and especially headache syndromes

Abstract

Purpose of reviewThis is an expert overview on recent literature about the complex relationship between coronavirus disease 2019 (COVID-19) and headache. Recent findingsLong COVID is a clinical syndrome characterized by the presence of persistent symptoms following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Headache is one of the most common symptoms and is described most often as throbbing pain, associated with photo and phonofobia and worsening with physical exercise. In acute COVID-19, headache is usually described as moderate or severe, diffuse and oppressive although sometimes it has been described with a migraine-like phenotype, especially in patients with a previous history of migraine. Headache intensity during acute phase seems to be the most important predictor of duration of headache over time. Some COVID-19 cases can be associated with cerebrovascular complications, and red flags of secondary headaches (e.g. new worsening or unresponsive headache, or new onset of neurological focal signs) should be urgently investigated with imaging. Treatment goals are the reduction of number and intensity of headache crises, and the prevention of chronic forms.

Health equity, care access and quality in headache – part 1

“…Several data report how patients with migraine and co-infection from SARS-CoV-2 complain of more intense pain which is often less responsive to common analgesics [ 23 ]. Patients with a migraine history and a migraine-like phenotype can respond well to triptans, while those with a TTH-like phenotype can be improved by single doses of paracetamol [ 24 ]. A good response rate in term of pain relief has been obtained with indomethacin in patients with the migraine-like phenotype, however several side effects are associated with its long-term use (e.g.…”

“…Less evidence argues in favor of hypoxia, hypercapnia and of the direct neuronal tissue invasion from SARS-CoV-2 [ 33 ]. Persistent immune system activation from cytokine hyperproduction, unresolved neuronal damage or meningeal inflammation may account for the persistent headache in long COVID, and other neurological manifestations such as cognitive deficits and brain fog may be related to an glutamate hyperproduction and upregulation of N-methyl-D-aspartate (NMDA) receptors [ 24 ].…”

COVID-19 related headaches: epidemiology, pathophysiology, impacts, and management

“…Headache due to COVID-19 typically presents within the first few days of an acute infection and predominantly bifrontal or holocranial [20][21][22]. It could be diffuse in some patients and pressing [23 ]. It may be frequent and similar to a tension-type headache or migraine-like especially in those with a previous history of migraine [23 ,24 & ].…”

“…There is some indication that the presence of headache in adults is linked to younger age, fewer comorbidities, and reduced mortality [18]. When headaches occur in patients with comorbidities, it may be more intense and frequent than in patients without comorbidities [23 ]. Individuals with blood group B may be more likely to develop complications post-COVID-19 and experience symptoms including headaches compared with individuals with blood group O [36].…”

Headaches and facial pain attributed to SARS‐CoV‐2 infection and vaccination: a systematic review

“…Like other coronaviruses, SARS-CoV-2 targets the human respiratory system primarily but it can also lead to nervous system dysfunction [2][3][4]. Headache is experienced as a presenting symptom in COVID-19 and as an adverse event (AE) of the SARS-CoV-2 vaccines, as well as a key symptom in the condition that occasionally follows the resolution of acute COVID-19, the so-called post-COVID-19 condition [5][6][7]. According to the World Health Organization, the post-COVID-19 condition is defined as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation [8].…”