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Observational Study
. 2020 Nov;40(13):1432-1442.
doi: 10.1177/0333102420965146.

Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients

Javier Trigo López  1 , David García-Azorín  1   2 , Álvaro Planchuelo-Gómez  3 , Cristina García-Iglesias  3 , Carlos Dueñas-Gutiérrez  4 , Ángel L Guerrero  1   2   5
Affiliations
Observational Study

Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients

Javier Trigo López et al. Cephalalgia. 2020 Nov.

Abstract

Introduction: Headache is a common symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, we aimed to characterize the phenotype of headache attributed to SARS-CoV-2 infection and to test the International Classification of Headache Disorders (ICHD-3) phenotypic criteria for migraine and tension-type headache.

Methods: The study design was a cross-sectional study nested in a cohort. We screened all consecutive patients that were hospitalized and had a positive SARS-CoV-2 test. We included patients that described headache if the headache was not better explained by another ICHD-3 diagnosis. Patients were interviewed by two neurologists.

Results: We screened 580 patients and included 130 (mean age 56 years, 64% female). Headache was the first symptom of the infection in 26% of patients and appeared within 24 hours in 62% of patients. The headache was bilateral in 85%, frontal in 83%, and with pressing quality in 75% of patients. Mean intensity was 7.1, being severe in 64%. Hypersensitivity to stimuli occurred in 57% of patients. ICHD-3 criteria for headache attributed to systemic viral infection were fulfilled by 94% of patients; phenotypic criteria for migraine were fulfilled by 25% of patients, and tension-type headache criteria by 54% of patients.

Conclusion: Headache attributed to SARS-CoV-2 infection in hospitalized patients has severe intensity, frontal predominance and oppressive quality. It occurs early in the course of the disease. Most patients fulfilled ICHD-3 criteria for headache attributed to systemic viral infection; however, the phenotype might resemble migraine in a quarter of cases and tension-type headache in half of the patients.

Keywords: COVID-19; headache disorders; migraine disorders; nervous system diseases; secondary; tension-type headache.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of screened, included and excluded patients, with the reasons for exclusion. † means deceased patient.
Figure 2.
Figure 2.
Interval (in days) between the first COVID-19 symptom and the headache onset. Frequency of patients.
Figure 3.
Figure 3.
Topography of the headache. Number of patients that described pain in each topography.
Figure 4.
Figure 4.
Intensity of the headache on a 0–10 numeric rating scale (NRS).
Figure 5.
Figure 5.
Degree of disability on a 0–100 numeric rating scale (NRS).
See this image and copyright information in PMC

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