Several people had been prescribed preventives prior to initial evaluation but stopped them because of side effects or ineffectiveness. Improvement in headache since onset occurred for 83.7% of the cohort. Response to Headache TreatmentĪt the initial consultation, 72.0% of the cohort had been prescribed a new preventive treatment and 28% were prescribed a new abortive treatment. No prior brain MRIs were available for comparison. Among the 12 individuals with nonspecific microvascular white matter changes, 7 had risk factors for small vessel changes (eg, a history of hypertension, hyperlipidemia, diabetes, or migraine). Neuroimaging FindingsĪmong the 33 individuals who had brain MRIs, 60.6% had no significant findings, 36.3% had nonspecific microvascular white matter changes, and 3.0% (1 person) had mild communicating hydrocephalus. Comorbid neuropsychiatric symptoms included cognitive difficulties, insomnia, and anxiety/depression. The mean number of headache days per month was 16.7☑1.3. A period with no headaches after COVID-19 and before onset of current headache type was experienced by 30%. Many had a new headache type that differed from the headaches they had prior to COVID-19. Several patients had multiple types of headaches.
Chronic migraine, migraine without aura and tension-type headaches were the most common. Half of the cohort had a history of tension or migraine headache prior to acute COVID-19. The characteristics of headache seen in this long COVID clinic are summarized in Table 2. Hospitalization for COVID-19 had occurred for 22%, and 88% had positive test results for COVID-19 verified by antigen, polymerase chain reaction (PCR), or antibody (for those diagnosed prior to vaccination availability) tests.
The average length of time from acute COVID-19 to neurology consultation was 32.6 weeks. Long COVID-Related Headache Characteristics The evaluations occurred from Februthrough February 21, 2022. Demographic data (Table 1) recorded included gender, age, race, and medical history. The first 50 consecutive adults with headache, who were seen at least 6 weeks after their diagnosis with COVID-19 in a clinic specializing in neurologic complications of long COVID were evaluated by a single neurologist. 6 In this article, we describe long COVID-related headache attributes in a cohort of 50 persons with persistent headaches after recovery from acute COVID-19. In contrast, in long COVID-related headache, it has been postulated that the trigeminovascular system-which can be activated during the inflammatory state of an active infection-is somehow sensitized, leading to more frequent headaches that persist beyond acute COVID-19. Acute and chronic headache attributed to systemic viral infection is described in the International Classification of Headache Disorders, 3rd edition (ICHD-3) but is supposed to directly coincide with viral illness and significantly improve as the viral illness resolves. Persistent headache after recovery from acute COVID-19 is being increasingly recognized, but the specific attributes of these headaches are not well characterized. 4 Patients with a preexisting migraine or tension-type headache were found to have a significantly higher frequency of COVID-19–related headache. 3 A large study surveyed individuals with headache and found that bilateral headache, duration longer than 72 hours, and analgesic resistance were significant variables differentiating headache in people with vs without COVID-19. Most reports in the literature describe COVID-19–related headache in the context of acute COVID-19, which is typically severe, holocranial, and rapidly evolving with migraine-like qualities, including throbbing pain, aggravation by routine movements, and sensory disturbances. Most studies to date list the various symptoms of long COVID (ie, headache, fatigue, neuropsychiatric symptoms, and cognitive difficulties) without detailing the characteristics of these symptoms. 2 Understanding of the mechanism or clinical course of long COVID remains limited. 1 Long-term symptoms can occur even in those who recovered from mild-to-moderate acute COVID-19 without hospitalization. 1 In those with long COVID, approximately 80% developed at least 1 long-term symptom 2 or more weeks after acute COVID-19, with headache among the most common of these symptoms. The post-acute sequelae of SARS-CoV-2, otherwise known as “long COVID,” refers to the persistence of symptoms weeks to months after initial infection with SARS-CoV-2, the virus that causes COVID-19.
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