Headache associated with COVID-19: Epidemiology, characteristics, pathophysiology, and management

Objective: To review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID-19-associated headache. The persistence of headache after the acute phase of COVID-19 was also reviewed.

Background: Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease.

Method: This is a narrative review. A literature review was conducted in the PubMed database with the following terms: "headache" and "COVID-19." All articles written in English that were considered relevant were included.

Results: Half of the patients who have COVID-19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension-type headache. All studies found the migraine pattern and the tension-type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti-inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID-19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients' headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID-19 may trigger new daily persistent headache.

Conclusions: Headache is a clinically significant symptom of COVID-19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.