Heterogeneous Headache Characteristics Associated With COVID-19

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The heterogeneous expression of headache associated with COVID-19 indicates various underlying pathophysiological mechanisms.

The heterogeneous expression of headache associated with coronavirus disease 2019 (COVID-19) indicates various underlying pathophysiological mechanisms, according to results of a survey published in Headache.

Though headaches have been shown to be a symptom of COVID-19 in up to 60% of cases, no study has yet been done to analyze the characteristics of headaches in these patients.

To assess this, survey data from 112 healthcare professionals (81.3% women) who had been diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and presented with headache were analyzed. Laboratory diagnosis, including reverse transcription polymerase chain reaction (RT-PCR) or serological tests, was not performed in 80% of cases due to the unavailability of tests. That majority of SARS-CoV-2 infection was diagnosed via clinical presentation.

The mean age of participants was 43.4±11.4 years. The majority (74.1%) of respondents did not have a history of frequent headache. There was no fever in 88.4% of respondents. The most common forms of headache reported were hemicranial (46.0%), holocranial (42.5%), and occipital (17.7%) with pressing pain presenting in 80.4% of cases.

This survey indicated that SARS-CoV-2 infection can cause headache in patients without a history of frequent headache. The heterogeneity of headache manifestations suggests various potential causes. The pathology of the headache is not yet determined and may be indirectly caused by the virus, such as psychological factors or the use of personal protective equipment, though the coincidence of the onset of headache symptoms with the onset of other viral symptoms suggests the headaches may be caused by the virus itself.

A significant difference in headache characteristics between individuals who had a history of headaches and those who did not was of particular interest and warrants further study.

Limitations of this study include its inability to diagnose all participants with SARS-CoV-2 infection through laboratory tests.


Porta-Etessam J, Matías-Guiu JA, González-García N, et al. Spectrum of headaches associated with SARS-CoV-2 infection: Study of healthcare professionals. Published online July 15, 2020. Headache. doi:10.1111/head.13902