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

• Published in: Cephalalgia Vol. 40; no. 13; p. 1432
• Main Authors: López, Javier Trigo, García-Azorín, David, Planchuelo-Gómez, Álvaro, García-Iglesias, Cristina, Dueñas-Gutiérrez, Carlos, Guerrero, Ángel L
• Format: Journal Article
• Language: English
• Published: England 01-11-2020
• Subjects: Adult; Aged; Betacoronavirus; Coronavirus Infections - complications; COVID-19; Cross-Sectional Studies; Female; Headache - classification; Headache - diagnosis; Headache - virology; Humans; International Classification of Diseases; Male; Middle Aged; Pandemics; Phenotype; Pneumonia, Viral - complications; SARS-CoV-2; COVID-19; secondary; nervous system diseases; headache disorders; tension-type headache; migraine disorders
• ISSN: 1468-2982
• DOI: 10.1177/0333102420965146

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.
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.
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.
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.