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García-Azorín D, García-Ruiz C, Sierra-Mencía Á, González-Osorio Y, Recio-García A, González-Celestino A, García-Iglesias C, Planchuelo-Gómez Á, Íñiguez AE, Guerrero-Peral ÁL. Acute and Preventive Treatment of COVID-19-Related Headache: A Series of 100 Patients. Life (Basel) 2024; 14:910. [PMID: 39063663 PMCID: PMC11277981 DOI: 10.3390/life14070910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
To describe the need and effectiveness of acute and preventive medications in a series of 100 consecutive patients referred due to COVID-19-related headaches. Patients were aged 48.0 (standard deviation (SD): 12.4), 84% were female, and 56% had a prior history of headache. The most common headache phenotype was holocranial (63%), frontal (48%), pressing (75%), of moderate intensity (7 out of 10), and accompanied by photophobia (58%). Acute medication was required by 93%, with paracetamol (46%) being the most frequently used drug, followed by ibuprofen (44%). The drugs with the highest proportion of a 2 h pain-freedom response were dexketoprofen (58.8%), triptans (57.7%), and ibuprofen (54.3%). Preventive treatment was required by 75% of patients. The most frequently used drugs were amitriptyline (66%), anesthetic blockades (18%), and onabotulinumtoxinA (11%). The drugs with the highest 50% responder rate were amitriptyline (45.5%), mirtazapine (50%), and anesthetic blockades (38.9%). The highest 75% responder rate was experienced following onabotulinumtoxinA (18.2%). In conclusion, most patients required acute medication, with triptans and non-steroidal anti-inflammatory drugs achieving the best responses. Three-quarters of patients required preventive medication. The most frequently used drug was amitriptyline, which obtained the best results. In some treatment-resistant patients, anesthetic blockades and onabotulinumtoxinA were also beneficial.
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Affiliation(s)
- David García-Azorín
- Department of Medicine, Toxicology and Dermatology, Faculty of Medicine, University of Valladolid, 47002 Valladolid, Spain;
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Claudia García-Ruiz
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Álvaro Sierra-Mencía
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Yésica González-Osorio
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Andrea Recio-García
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Ana González-Celestino
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Cristina García-Iglesias
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
| | - Álvaro Planchuelo-Gómez
- Imaging Processing Laboratory, Escuela Superior de Telecomunicaciones (ETSI), Universidad de Valladolid, 47002 Valladolid, Spain;
| | | | - Ángel L. Guerrero-Peral
- Department of Medicine, Toxicology and Dermatology, Faculty of Medicine, University of Valladolid, 47002 Valladolid, Spain;
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (C.G.-R.); (Á.S.-M.); (Y.G.-O.); (A.R.-G.); (A.G.-C.); (C.G.-I.)
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2
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Mitsikostas DD, Caronna E, De Tommaso M, Deligianni CI, Ekizoglu E, Bolay H, Göbel CH, Kristoffersen ES, Lampl C, Moro E, Pozo‐Rosich P, Sellner J, Terwindt G, Irimia‐Sieira P. Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review. Eur J Neurol 2024; 31:e16251. [PMID: 38415282 PMCID: PMC11235838 DOI: 10.1111/ene.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND PURPOSE The aim was to provide insights to the characteristics of headache in the context of COVID-19 on behalf of the Headache Scientific Panel and the Neuro-COVID-19 Task Force of the European Academy of Neurology (EAN) and the European Headache Federation (EHF). METHODS Following the Delphi method the Task Force identified six relevant questions and then conducted a systematic literature review to provide evidence-based answers and suggest specific diagnostic criteria. RESULTS No data for facial pain were identified in the literature search. (1) Headache incidence during acute COVID-19 varies considerably, with higher prevalence rates in prospective compared to retrospective studies (28.9%-74.6% vs. 6.5%-34.0%). (2) Acute COVID-19 headache is usually bilateral or holocranial and often moderate to severe with throbbing pain quality lasting 2-14 days after first signs of COVID-19; photo-phonophobia, nausea, anosmia and ageusia are common associated features; persistent headache shares similar clinical characteristics. (3) Acute COVID-19 headache is presumably caused by immune-mediated mechanisms that activate the trigeminovascular system. (4) Headache occurs in 13.3%-76.9% following SARS-CoV-2 vaccination and occurs more often amongst women with a pre-existing primary headache; the risk of developing headache is higher with the adenoviral-vector-type vaccines than with other preparations. (5) Headache related to SARS-CoV-2 vaccination is mostly bilateral, and throbbing, pressing, jolting or stabbing. (6) No studies have been conducted investigating the underlying mechanism of headache attributed to SARS-CoV-2 vaccines. CONCLUSION The results of this joint EAN/EHF initiative provide a framework for a better understanding of headache in the context of SARS-CoV-2 infection and vaccination.
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Affiliation(s)
| | - Edoardo Caronna
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina De Tommaso
- Neurophysiopathology Unit, DiBrain DepartmentAldo Moro UniversityBariItaly
| | | | - Esme Ekizoglu
- Department of Neurology, Faculty of MedicineIstanbul University, IstanbulIstanbulTurkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROMGazi University AnkaraAnkaraTurkey
| | - Carl H. Göbel
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Espen Saxhaug Kristoffersen
- Department of NeurologyAkershus University HospitalLørenskogNorway
- NorHEAD, Norwegian Centre for Headache ResearchAkershus University HospitalLørenskogNorway
- Department of General Practice, HELSAMUniversity of OsloOsloNorway
| | - Christian Lampl
- Department of Neurology and Stroke UnitKonventhospital Barmherzige Brüder LinzLinzAustria
- Headache Medical Center LinzLinzAustria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes UniversityGrenobleFrance
| | - Patricia Pozo‐Rosich
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Johann Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
| | - Gisela Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
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Sampaio Rocha-Filho PA. Headache Associated with Coronavirus Disease 2019. Neurol Clin 2024; 42:507-520. [PMID: 38575263 DOI: 10.1016/j.ncl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Headache affects around half of patients in the acute phase of COVID-19 and generally occurs at the beginning of the symptomatic phase, has an insidious onset, and is bilateral, and of moderate to severe intensity. COVID-19 may also present complications that cause acute and persistent headaches, such as cerebrovascular diseases, rhinosinusitis, meningitis, and intracranial hypertension. In 10% to 20% of patients with COVID-19, headache may persist beyond the acute phase. In general, the headache improves over time. To date, there are no clinical trials that have assessed the treatment of persistent post-COVID-19 headache.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil; Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Recife, Brazil.
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4
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Aiyegbusi OL. COVID-19 related headaches: epidemiology, pathophysiology, impacts, and management. Curr Opin Neurol 2023; 36:609-614. [PMID: 37865841 DOI: 10.1097/wco.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW This is an expert overview of the recent literature on the nature, epidemiology, pathophysiology, impact, and management of COVID-19 related headache, in the acute phase of infection and in post-COVID-19 syndrome. RECENT FINDINGS Headache is one of the commonest symptoms of COVID-19 during acute infection and it is often experienced by individuals who go on to develop long COVID. There is a higher prevalence of headache in individuals with long COVID who contracted the Delta variant than in those who were infected with the Wuhan or Alpha variants. Headaches related to COVID-19 infection are commoner and may be more intense in women.There are indications that presence of headache might indicate a more benign COVID-19 infection and a better chance of survival. However, the impact of COVID-19 related headache could be substantial leading to poor quality of life in individuals affected. Headache that changes in its nature in terms of frequency and severity should be investigated to exclude cerebrovascular complications. There are promising new therapies for its treatment, but further research is needed. SUMMARY The findings of this review can promote a better understanding of COVID-19 related headache and guide clinicians in the management of patients.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham
- NIHR Applied Research Collaboration (ARC) West Midlands
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
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Takizawa T, Ihara K, Uno S, Ohtani S, Watanabe N, Imai N, Nakahara J, Hori S, Garcia-Azorin D, Martelletti P. Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in COVID-19 patients: a narrative review. Expert Opin Drug Metab Toxicol 2023; 19:951-967. [PMID: 37925645 DOI: 10.1080/17425255.2023.2280221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Migraine pharmacological therapies targeting calcitonin gene-related peptide (CGRP), including monoclonal antibodies and gepants, have shown clinical effect and optimal tolerability. Interactions between treatments of COVID-19 and CGRP-related drugs have not been reviewed. AREAS COVERED An overview of CGRP, a description of the characteristics of each CGRP-related drug and its response predictors, COVID-19 and its treatment, the interactions between CGRP-related drugs and COVID-19 treatment, COVID-19 and vaccination-induced headache, and the neurological consequences of Covid-19. EXPERT OPINION Clinicians should be careful about using gepants for COVID-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, COVID-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a COVID-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.
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Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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Soares AP, de Lima Neto DF, Pour SZ, Passos SD, Cunha MDP, Zanotto PMDA. Evaluation of renal markers and liver enzymes in patients infected with the Chikungunya virus. J Med Virol 2023; 95:e29276. [PMID: 38100636 DOI: 10.1002/jmv.29276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
Chikungunya virus (CHIKV) is an arbovirus (Togaviridae family, Alphavirus genus) that was first identified in 1953 in Tanzania. In 2014, the Asian and East/Central/South/African (ECSA) genotypes were identified in Brazil, although the genotype that spread the most in the following years across the Brazilian territory was the ECSA. The clinical symptoms associated with the infection caused by CHIKV include mainly fever, myalgia, headache, and arthralgia. In infections caused by other arboviruses (such as the ones caused by Dengue and West Nile viruses), changes in biochemical markers are often observed. This study aims to evaluate the biochemical markers profile of kidney and liver injury in acute patients infected with CHIKV. Two groups of correlations were found between the variables analyzed, namely, one between liver enzymes (r = 0.91), and another for kidney markers (r = 0.54-0.66). A significant elevation in the percentage of altered creatinine in CHIKV-infected patients was observed, followed by uric acid and AST. Altogether, in 8 different comparisons, it was possible to observe statistically significant differences between the levels of the markers when compared to the manifestation of symptoms (presence and absence). These noticeable changes in marker measurements could potentially be connected to the range of clinical symptoms seen in the disease.
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Affiliation(s)
- Anderson Pereira Soares
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Ferreira de Lima Neto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Shahab Zaki Pour
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Saulo Duarte Passos
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo, Brazil
| | - Marielton Dos Passos Cunha
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paolo Marinho de Andrade Zanotto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
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Melgarejo L, Caronna E, Rosell-Mirmi J, Elosua-Bayés I, Alpuente A, Torres-Ferrus M, Gallardo VJ, Pozo-Rosich P. Migraine worsening after COVID-19 and COVID-19 vaccination: Are we facing a nocebo effect? Eur J Neurol 2023; 30:3877-3885. [PMID: 37791410 DOI: 10.1111/ene.16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND PURPOSE In clinical practice patients may report migraine worsening as a consequence of COVID-19 (either infection or vaccines), however, data in this area are lacking. We aimed to investigate the link between COVID-19 and COVID-19 vaccination with migraine worsening and its associated factors. METHODS An online survey was sent to migraine patients followed up in a Spanish Headache Clinic, collecting demographic data, and information regarding SARS-CoV-2 infection and vaccination. We asked patients if they had noticed worsening of their migraine after these events and assessed concerns about infection, vaccination and migraine worsening. We also extracted data from participants' own electronic diaries (e-diaries), including 1-month data before and after their reported infection and/or vaccination. We compared participants who self-reported migraine worsening since infection or vaccination with those who did not. RESULTS Of 550 participants, 44.9% (247/550) reported having had COVID-19 at least once and 83.3% (458/550) had been vaccinated. Sixty-one patients reported migraine worsening since COVID-19 and 52 since the vaccination. Among the risk factors for perceived migraine worsening in the two settings (infection and vaccination) was concern about migraine worsening itself (infection: odds ratio [OR] 2.498 [95% CI: 1.02-6.273], p = 0.046; vaccination: OR 17.3 [95% CI: confidence interval 5.3-68], p < 0.001). e-diary information was available for 136 of the 550 patients, 38.2% (52/136) for COVID-19 and 39.7% (54/136) for vaccination. We observed no significant difference in headache frequency 1 month before and after infection or vaccination, even when comparing patients with and without self-reported migraine worsening. CONCLUSIONS Our preliminary data point to a negligible role of the infection and vaccination on migraine worsening and to the possible presence of a nocebo effect in these settings, as a remarkable proportion of patients had a clear perception of migraine worsening.
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Affiliation(s)
- Laura Melgarejo
- Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Rosell-Mirmi
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor J Gallardo
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gómez-Dabó L, Melgarejo-Martínez L, Caronna E, Pozo-Rosich P. Headache in COVID-19 and Long COVID: to Know Facts for Clinical Practice. Curr Neurol Neurosci Rep 2023; 23:551-560. [PMID: 37665495 DOI: 10.1007/s11910-023-01296-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE OF REVIEW Headache is one of the most frequent symptoms of the acute and post-acute phase of COVID-19. Specific epidemiology, clinical features, risk factors, pathophysiology, and treatment have been reported in these two scenarios. With this narrative review of the literature, we aim to provide updated knowledge on headache in the COVID-19 setting and give clinicians a practical approach on this topic to guide them in their clinical practice. RECENT FINDINGS Headache mechanisms in COVID-19 are still poorly understood. Strong evidence is also lacking on how to best treat and manage these patients, especially those with persistent and disabling headache after COVID-19. Data are also scarce on the characteristics of headache in COVID-19 caused by the new SARS-CoV-2 (Omicron) variants and how these may influence the acute and persistent symptoms of COVID-19. Patients with pre-existing primary headache disorders remain a particularly concerning population due to their biological predisposition in suffering from headaches and the potential risk of worsening in the setting of SARS-CoV-2 infection. Although there is an exponential growth of scientific evidence, studies are often controversial and focused on the first wave of the pandemic, making COVID-19 headache still a challenging matter for clinicians. New research is therefore needed.
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Affiliation(s)
- Laura Gómez-Dabó
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Melgarejo-Martínez
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Mehri A, Sotoodeh Ghorbani S, Farhadi-Babadi K, Rahimi E, Barati Z, Taherpour N, Izadi N, Shahbazi F, Mokhayeri Y, Seifi A, Fallah S, Feyzi R, Etemed K, Hashemi Nazari SS. Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study. J Intensive Care Med 2023; 38:825-837. [PMID: 36976873 PMCID: PMC10051011 DOI: 10.1177/08850666231166344] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/09/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
Objectives: This study aims to investigate the risk factors associated with severity and death from COVID-19 through a systematic review and meta-analysis of the published documents in Iran. Methods: A systematic search was performed based on all articles indexed in Scopus, Embase, Web of Science (WOS), PubMed, and Google Scholar in English and Scientific Information Database (SID) and Iranian Research Institute for Information Science and Technology (IRA)NDOC indexes in Persian. To assess quality, we used the Newcastle Ottawa Scale. Publication bias was assessed using Egger's tests. Forest plots were used for a graphical description of the results. We used HRs, and ORs reported for the association between risk factors and COVID-19 severity and death. Results: Sixty-nine studies were included in the meta-analysis, of which 62 and 13 had assessed risk factors for death and severity, respectively. The results showed a significant association between death from COVID-19 and age, male gender, diabetes, hypertension, cardiovascular disease (CVD), cerebrovascular disease, chronic kidney disease (CKD), Headache, and Dyspnea. We observed a significant association between increased white blood cell (WBC), decreased Lymphocyte, increased blood urea nitrogen (BUN), increased creatinine, vitamin D deficiency, and death from COVID-19. There was only a significant relationship between CVD and disease severity. Conclusion: It is recommended that the predictive risk factors of COVID-19 severity and death mentioned in this study to be used for therapeutic and health interventions, to update clinical guidelines and determine patients' prognoses.
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Affiliation(s)
- Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Farhadi-Babadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Rahimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Barati
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloufar Taherpour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Izadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences Hamadan, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yaser Mokhayeri
- Department of Infectious Disease, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Saeid Fallah
- Department of Epidemiology, School of Public Health and Safety, Prevention of Cardiovascular Disease Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Feyzi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemed
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health and Safety, Prevention of Cardiovascular Disease Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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van der Arend BWH, Bloemhof MM, van der Schoor AG, van Zwet EW, Terwindt GM. Effect of COVID vaccination on monthly migraine days: a longitudinal cohort study. Cephalalgia 2023; 43:3331024231198792. [PMID: 37684012 DOI: 10.1177/03331024231198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND This longitudinal cohort study aimed to investigate changes in migraine-related outcomes following COVID-19 infection and vaccination. METHODS We identified 547 clinically diagnosed migraine patients from the Leiden Headache Center who kept a headache E-diary during the COVID-19 pandemic (February 2020 to August 2022). We sent a questionnaire to register their COVID-19 infection and/or vaccination dates. After applying inclusion criteria, n = 59 participants could be included in the infection analysis and n = 147 could be included in the vaccination analysis. Primary outcome was the change in monthly migraine days (MMD) between 1 month prior and 1 month post COVID-19 infection or vaccination. Secondary outcome variables were change in monthly headache days (MHD) and monthly acute medication days (MAMD). RESULTS Vaccination against COVID-19 was associated with an increase in MMD (1.06; 95% confidence interval [CI] = 0.57-1.55; p < 0.001), MHD (1.52; 95% CI = 0.91-2.14; p < 0.001) and MAMD (0.72; 95% CI = 0.33-1.12; p < 0.001) in the first month post-vaccination. COVID-19 infection solely increased the number of MAMD (1.11; 95% CI = 0.10-1.62; p < 0.027), but no statistically significant differences in MMD or MHD were observed. CONCLUSIONS Our findings imply that vaccination against COVID-19 is associated with an increase in migraine, indicating a possible role of inflammatory mediators in migraine pathophysiology.
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Affiliation(s)
- Britt W H van der Arend
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Mirthe M Bloemhof
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Abstract
PURPOSE OF REVIEW This is an expert overview on recent literature about the complex relationship between coronavirus disease 2019 (COVID-19) and headache. RECENT FINDINGS Long COVID is a clinical syndrome characterized by the presence of persistent symptoms following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Headache is one of the most common symptoms and is described most often as throbbing pain, associated with photo and phonofobia and worsening with physical exercise. In acute COVID-19, headache is usually described as moderate or severe, diffuse and oppressive although sometimes it has been described with a migraine-like phenotype, especially in patients with a previous history of migraine. Headache intensity during acute phase seems to be the most important predictor of duration of headache over time. Some COVID-19 cases can be associated with cerebrovascular complications, and red flags of secondary headaches (e.g. new worsening or unresponsive headache, or new onset of neurological focal signs) should be urgently investigated with imaging. Treatment goals are the reduction of number and intensity of headache crises, and the prevention of chronic forms. SUMMARY This review can help clinicians to approach patients with headache and infection from SARS-CoV-2, with particular attention to persistent headache in long COVID.
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Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, Chieti
| | - Maria Adele Giamberardino
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, Chieti
- Department of Medicine and Science of Aging and CAST, G. D'Annunzio University of Chieti
| | - Paolo Martelletti
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
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12
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Trofor AC, Cernomaz AT, Lotrean LM, Crișan-Dabija RA, Penalvo JL, Melinte OE, Popa DR, Man MA. Prognostic Role of Clinical Features of Moderate Forms of COVID-19 Requiring Hospitalization. J Pers Med 2023; 13:900. [PMID: 37373889 DOI: 10.3390/jpm13060900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION We aimed to characterize the clinical features of moderate forms of COVID-19 requiring hospitalization and potentially identify predictors for unfavorable outcomes. METHODS Pooled anonymized clinical data from 452 COVID-19 patients hospitalized in two regional Romanian respiratory disease centers during the Alpha and Delta variant outbreaks were included in the analysis. RESULTS Cough and shortness of breath were the most common clinical features; older patients exhibited more fatigue and dyspnea and fewer upper airway-related symptoms such as smell loss or sore throat. The presence of confusion, shortness of breath and age over 60 years were significantly associated with worse outcomes (odds ratios 5.73, 2.08 and 3.29, respectively). CONCLUSION The clinical picture on admission may have a prognostic role for moderate forms of COVID-19. Clear clinical definitions and developing adequate informational infrastructure allowing complex data sharing and analysis might be useful for fast research response should a similar outbreak occur in the future.
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Affiliation(s)
- Antigona Carmen Trofor
- Discipline of Pneumology, III-rd Medical Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Andrei Tudor Cernomaz
- Discipline of Pneumology, III-rd Medical Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Lucia Maria Lotrean
- Discipline of Hygiene, Department of Community Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj, Romania
| | - Radu Adrian Crișan-Dabija
- Discipline of Pneumology, III-rd Medical Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Jose L Penalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Oana Elena Melinte
- Discipline of Pneumology, III-rd Medical Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Robu Popa
- Discipline of Pneumology, III-rd Medical Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Milena Adina Man
- Discipline of Pneumology, Department of Medical Sciences, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj, Romania
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13
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Calvache-Mateo A, López-López L, Martín-Núñez J, Heredia-Ciuró A, Granados-Santiago M, Ortiz-Rubio A, Valenza MC. Pain and Clinical Presentation: A Cross-Sectional Study of Patients with New-Onset Chronic Pain in Long-COVID-19 Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054049. [PMID: 36901059 PMCID: PMC10001485 DOI: 10.3390/ijerph20054049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 06/01/2023]
Abstract
The aim of this study was to evaluate the characteristics of pain (i.e., pain intensity, pain interference, clinical presentation) in Long-COVID-19 patients and compare the location of pain between successfully recovered COVID-19 patients and healthy matched controls. A cross-sectional case-control study was carried out. Long-COVID-19 patients, age- and sex-matched patients with a history of COVID-19 who had successfully recovered, and healthy controls were included. Outcomes included were pain characteristics (Brief Pain Inventory and Short-Form McGill Pain Questionnaire) and clinical presentation (Widespread Pain Index and Euroqol-5 Dimensions 5 Levels Visual Analogue Scale). Sixty-nine patients with Long-COVID-19 syndrome, sixty-six successfully recovered COVID-19 patients, and sixty-seven healthy controls were evaluated. Patients with Long-COVID-19 syndrome showed greater pain intensity and interference. In addition, they showed worse quality of life and greater widespread pain, with the most frequent locations of pain being the neck, legs, and head. In conclusion, patients with Long-COVID-19 syndrome show a high prevalence of pain, characterized by widespread pain of moderate intensity and interference, with the most frequent locations being the neck, legs, and head, significantly affecting the quality of life of these patients.
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Affiliation(s)
- Andrés Calvache-Mateo
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Laura López-López
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Javier Martín-Núñez
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Alejandro Heredia-Ciuró
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Araceli Ortiz-Rubio
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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14
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Fernández-de-Las-Peñas C, Cuadrado ML, Gómez-Mayordomo V, García-Azorín D, Arendt-Nielsen L. Headache as a COVID-19 onset symptom or Post-COVID symptom according to the SARS-CoV-2 Variant. Expert Rev Neurother 2023; 23:179-186. [PMID: 36857191 DOI: 10.1080/14737175.2023.2185138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION COVID19 associated headaches are highly common and there is currently an unmet need to better understand their association with SARSCoV2 variants. Headaches are a prevalent symptom in the acute phase of COVID19 and are associated with a better prognosis and better immune response. They are also a relevant post-COVID symptom. AREAS COVERED This article analyses the differences in the prevalence of headache as an onset symptom and in post-COVID headache among the different SARS-CoV-2 variants: the historical strain, Alpha, Delta and Omicron. The different pathophysiological mechanisms by which SARS-CoV-2 infection may cause headache are also discussed. EXPERT OPINION The presence of headache at the acute phase is a risk factor for post-COVID headache, whereas a history of primary headache does not appear to be associated with post-COVID headache. The prevalence of headache as an onset symptom appears to be variable for the different SARS-CoV-2 variants, but current data are inconclusive. However, the current evidence also suggests that headache represents a prevalent symptom in the acute and post-infection COVID-19 phase, regardless of SARS-CoV-2 variant.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Victor Gómez-Mayordomo
- Department of Neurology, Institute of Neurosciences, Vithas Madrid La Milagrosa University Hospital. Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, AMech-Sense, alborg University Hospital, Aalborg, Denmark
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15
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Planchuelo-Gómez Á, García-Azorín D, Guerrero ÁL, Rodríguez M, Aja-Fernández S, de Luis-García R. Structural brain changes in patients with persistent headache after COVID-19 resolution. J Neurol 2023; 270:13-31. [PMID: 36178541 PMCID: PMC9522538 DOI: 10.1007/s00415-022-11398-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/09/2023]
Abstract
Headache is among the most frequently reported symptoms after resolution of COVID-19. We assessed structural brain changes using T1- and diffusion-weighted MRI processed data from 167 subjects: 40 patients who recovered from COVID-19 but suffered from persistent headache without prior history of headache (COV), 41 healthy controls, 43 patients with episodic migraine and 43 patients with chronic migraine. To evaluate gray matter and white matter changes, morphometry parameters and diffusion tensor imaging-based measures were employed, respectively. COV patients showed significant lower cortical gray matter volume and cortical thickness than healthy subjects (p < 0.05, false discovery rate corrected) in the inferior frontal and the fusiform cortex. Lower fractional anisotropy and higher radial diffusivity (p < 0.05, family-wise error corrected) were observed in COV patients compared to controls, mainly in the corpus callosum and left hemisphere. COV patients showed higher cortical volume and thickness than migraine patients in the cingulate and frontal gyri, paracentral lobule and superior temporal sulcus, lower volume in subcortical regions and lower curvature in the precuneus and cuneus. Lower diffusion metric values in COV patients compared to migraine were identified prominently in the right hemisphere. COV patients present diverse changes in the white matter and gray matter structure. White matter changes seem to be associated with impairment of fiber bundles. Besides, the gray matter changes and other white matter modifications such as axonal integrity loss seemed subtle and less pronounced than those detected in migraine, showing that persistent headache after COVID-19 resolution could be an intermediate state between normality and migraine.
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Affiliation(s)
- Álvaro Planchuelo-Gómez
- Laboratorio de Procesado de Imagen (LPI), Universidad de Valladolid, 47011, Valladolid, Spain
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, CF24 4HQ, UK
| | - David García-Azorín
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47003, Valladolid, Spain.
- Department of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain.
| | - Ángel L Guerrero
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47003, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, 47005, Valladolid, Spain
| | - Margarita Rodríguez
- Department of Radiology, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
| | - Santiago Aja-Fernández
- Laboratorio de Procesado de Imagen (LPI), Universidad de Valladolid, 47011, Valladolid, Spain
| | - Rodrigo de Luis-García
- Laboratorio de Procesado de Imagen (LPI), Universidad de Valladolid, 47011, Valladolid, Spain
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16
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Caronna E, van den Hoek TC, Bolay H, Garcia-Azorin D, Gago-Veiga AB, Valeriani M, Takizawa T, Messlinger K, Shapiro RE, Goadsby PJ, Ashina M, Tassorelli C, Diener HC, Terwindt GM, Pozo-Rosich P. Headache attributed to SARS-CoV-2 infection, vaccination and the impact on primary headache disorders of the COVID-19 pandemic: A comprehensive review. Cephalalgia 2023; 43:3331024221131337. [PMID: 36606562 DOI: 10.1177/03331024221131337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective is to summarize the knowledge on the epidemiology, pathophysiology and management of secondary headache attributed to SARS-CoV-2 infection and vaccination; as well as to delineate their impact on primary headache disorders. METHODS This is a narrative review of the literature regarding primary and secondary headache disorders in the setting of COVID-19 pandemic. We conducted a literature search in 2022 on PubMed, with the keywords "COVID 19" or "vaccine" and "headache" to assess the appropriateness of all published articles for their inclusion in the review. RESULTS Headache is a common and sometimes difficult-to-treat symptom of both the acute and post-acute phase of SARS-CoV-2 infection. Different pathophysiological mechanisms may be involved, with the trigeminovascular system as a plausible target. Specific evidence-based effective therapeutic options are lacking at present. Headache attributed to SARS-CoV-2 vaccinations is also common, its pathophysiology being unclear. People with primary headache disorders experience headache in the acute phase of COVID-19 and after vaccination more commonly than the general population. Pandemic measures, forcing lifestyle changes, seemed to have had a positive impact on migraine, and changes in headache care (telemedicine) have been effectively introduced. CONCLUSIONS The ongoing COVID-19 pandemic is a global challenge, having an impact on the development of secondary headaches, both in people with or without primary headaches. This has created opportunities to better understand and treat headache and to potentiate strategies to manage patients and ensure care.
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Affiliation(s)
- Edoardo Caronna
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROM, Gazi University Hospital, Ankara, Turkey
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, Erlangen-Nuernberg, Germany
| | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, USA
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK.,Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Hans-Christoph Diener
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE) Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patricia Pozo-Rosich
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Marcolino MS, Anschau F, Kopittke L, Pires MC, Barbosa IG, Pereira DN, Ramos LEF, Assunção LFI, Costa ASDM, Nogueira MCA, Duani H, Martins KPMP, Moreira LB, Silva CTCAD, Oliveira NRD, Ziegelmann PK, Guimarães-Júnior MH, Lima MOSDS, Aguiar RLO, Menezes LSM, Oliveira TF, Souza MD, Farace BL, Cimini CCR, Maurílio ADO, Guimarães SMM, Araújo SF, Nascimento GF, Silveira DV, Ruschel KB, Oliveira TCD, Schwarzbold AV, Nasi LA, Floriani MA, Santos VBD, Ramos CM, Alvarenga JCD, Scotton ALBA, Manenti ERF, Crestani GP, Batista JDL, Ponce D, Machado-Rugolo J, Bezerra AFB, Martelli PJDL, Vianna HR, Castro LCD, Medeiros CRG, Vietta GG, Pereira EC, Chatkin JM, Godoy MFD, Delfino-Pereira P, Teixeira AL. Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort. J Neurol Sci 2022; 443:120485. [PMID: 36375382 PMCID: PMC9645948 DOI: 10.1016/j.jns.2022.120485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. METHODS This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. RESULTS From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. CONCLUSION COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.
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Affiliation(s)
- Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 110, Belo Horizonte, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190, sala 246, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS/ CNPq). R. Ramiro Barcelos, 2359, Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Fernando Anschau
- Grupo Hospitalar Conceição. Brazilian National Health System, Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor. Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | - Luciane Kopittke
- Grupo Hospitalar Conceição. Brazilian National Health System, Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor. Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, ICEx, sala 4071, Belo Horizonte, Brazil.
| | - Izabela Guimarães Barbosa
- Mental Health Department, Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190, sala 246, Belo Horizonte, Brazil.
| | - Daniella Nunes Pereira
- Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, ICEx, sala 4071, Belo Horizonte, Brazil.
| | - Luís Fernando Israel Assunção
- Department of Statistics, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, ICEx, sala 4071, Belo Horizonte, Brazil.
| | | | | | - Helena Duani
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 110, Belo Horizonte, Brazil.
| | - Karina Paula Medeiros Prado Martins
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 110, Belo Horizonte, Brazil.
| | | | | | | | | | | | | | | | - Luanna Silva Monteiro Menezes
- Instituto Mário Penna, Hospital Luxemburgo. R. Joaquim Cândido Filho, 91, Belo Horizonte, Brazil; Hospital Metropolitano Odilon Behrens. R. Formiga, 50, Belo Horizonte, Brazil.
| | | | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens. R. Formiga, 50, Belo Horizonte, Brazil.
| | - Bárbara Lopes Farace
- Hospital Risoleta Tolentino Neves. R. das Gabirobas, 01, Belo Horizonte, Brazil.
| | | | | | | | | | | | | | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/ CNPq). R. Ramiro Barcelos, 2359, Prédio 21, Sala 507, Porto Alegre, Brazil; Hospital Universitário Canoas. Av. Farroupilha, 8001, Canoas, Rio Grande do Sul, Brazil.
| | | | | | - Luiz Antônio Nasi
- Hospital Moinhos de Vento. R. Ramiro Barcelos, 910, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Maiara Anschau Floriani
- Hospital Moinhos de Vento. R. Ramiro Barcelos, 910, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Veridiana Baldon Dos Santos
- Grupo Hospitalar Conceição. Brazilian National Health System, Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor. Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | | | | | | | | | | | | | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu. Av. Professor Mário Rubens Guimarães Montenegro, Botucatu, São Paulo, Brazil.
| | - Juliana Machado-Rugolo
- Hospital das Clínicas da Faculdade de Medicina de Botucatu. Av. Professor Mário Rubens Guimarães Montenegro, Botucatu, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | - Polianna Delfino-Pereira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 110, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS/ CNPq). R. Ramiro Barcelos, 2359, Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Antonio Lucio Teixeira
- Faculdade Santa Casa BH. Av. dos Andradas, 2688, Belo Horizonte, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, UT Health Houston. 7000 Fannin St, Houston, EUA, USA.
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18
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Elkurwi N, Elkurwi Q. The Pathophysiological Relationship Between Migraine and SARS-CoV-2 Infection: A Comprehensive Literature Review. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10054250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
People with migraine, and individuals with other neurological conditions, have suffered in multiple aspects during the COVID-19 pandemic. This paper will discuss the factors that impacted the neurology department. The emergence of severe acute respiratory syndrome coronavirus 2 in late 2019 has generated new challenges in healthcare systems across the globe. Similar to the fields of pulmonology and cardiology that saw an increase in research, the neurology department was in search of possible relationships between COVID-19 and other medical conditions. Research on the possible common pathophysiological mechanism between COVID-19 and migraine is currently being studied. The most recent hypothesis suggests the following: migraine is caused by an increased release of calcitonin gene-related peptide from the trigeminal ganglion, which will cause an increase in nitric oxide and IL-1β, resulting in vasodilation and inducing hyperalgesia. COVID-19 causes an increase in nod-like receptor protein 3, which causes the production of IL-1β and again induces an inflammatory response. This review article looks at the mechanisms of migraine and COVID-19, and tries to link a common pathophysiological pathway between the two. This report also serves as a gateway for further research regarding possible management that could potentially target both of these mechanisms.
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Affiliation(s)
- Noor Elkurwi
- Department of Neurology, Stroke and Neurorehabilitation, Barlicki Hospital, Medical University of Łódź, Poland
| | - Qabas Elkurwi
- Department of Neurology, Stroke and Neurorehabilitation, Barlicki Hospital, Medical University of Łódź, Poland
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19
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Tana C, Bentivegna E, Cho SJ, Harriott AM, García-Azorín D, Labastida-Ramirez A, Ornello R, Raffaelli B, Beltrán ER, Ruscheweyh R, Martelletti P. Long COVID headache. J Headache Pain 2022; 23:93. [PMID: 35915417 PMCID: PMC9340759 DOI: 10.1186/s10194-022-01450-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Headache is among the most frequent symptoms persisting or newly developing after coronavirus disease 2019 (COVID-19) as part of the so-called long COVID syndrome. The knowledge on long COVID headache is still limited, however growing evidence is defining the features of this novel condition, in particular regarding clinical characteristics, some pathophysiological mechanisms and first treatment recommendations. Long COVID headache can present in the form of worsening of a preexisting primary headache, or, more specifically, in the form of a new (intermittent or daily) headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms, most frequently with hyposmia. It can manifest with a migrainous or, more frequently, with a tension-type-like phenotype. Persistent activation of the immune system and trigeminovascular activation are thought to play a role. As there are virtually no treatment studies, treatment currently is largely guided by the existing guidelines for primary headaches with the corresponding phenotype. The present report, a collaborative work of the international group of the Junior Editorial Board of The Journal of Headache and Pain aims to summarize the most recent evidence about long COVID headache and suggests approaches to the diagnosis and treatment of this disorder.
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Affiliation(s)
- Claudio Tana
- Center of Excellence On Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, 66100, Chieti, Italy.
| | - Enrico Bentivegna
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Andrea M Harriott
- Headache and Neuropathic Pain Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Labastida-Ramirez
- Headache Group, Wolfson Center for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Raffaele Ornello
- Departement of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eloísa Rubio Beltrán
- Headache Group, Wolfson Center for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Migraine and Headache Society, Frankfurt, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Paolo Martelletti
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
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20
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Gonzalez-Martinez A, Guerrero-Peral ÁL, Arias-Rivas S, Silva L, Sierra Á, Gago-Veiga AB, García-Azorín D. Amitriptyline for post-COVID headache: effectiveness, tolerability, and response predictors. J Neurol 2022; 269:5702-5709. [PMID: 35829760 PMCID: PMC9553757 DOI: 10.1007/s00415-022-11225-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Headache is one of the most frequently reported symptoms in post-COVID patients. The clinical phenotype of COVID-19 headache combines phenotypic features of both tension-type headache (TTH) and migraine. We aimed to assess the effectiveness, side effects and predictors of amitriptyline (AMT) response in a real-world study setting. METHODS We performed an observational multicentric study with a retrospective cohort. All consecutive patients with confirmed COVID-19 infection who received AMT for post-COVID headache from March 2020 to May 2021 were included. Response was evaluated by the reduction in the number of headache days per month (HDM) between weeks 8 and 12, compared with the baseline. We explored which variables were associated with a higher probability of response to AMT. RESULTS Forty-eight patients were eligible for the study, 40/48 (83.3%) females, aged 46.85 (SD: 13.59) years. Patients had history of migraine 15/48 (31.3%) or TTH 5/48 (10.4%). The mean reduction of HDM was 9.6 (SD: 10.9; 95% CI 6.5, 12.7) days. Only 2/48 (5%) of patients discontinued AMT due to poor tolerability. History of TTH (10.9, 95% CI 1.3, 20.6) and nausea (- 8.5, 95% CI - 14.6, - 2.5) were associated with AMT response. CONCLUSIONS This study provides real-world evidence of the potential benefit of AMT in patients with post-COVID-19 headache, especially in patients with history of TTH and without concomitant nausea.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
- Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- Department of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
| | - Susana Arias-Rivas
- Department of Neurology, Hospital Santiago de Compostela, Galicia, Spain
| | - Lorenzo Silva
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Álvaro Sierra
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
- Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain
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21
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Sampaio Rocha-Filho PA, Magalhães JE, Fernandes Silva D, Carvalho Soares M, Marenga Arruda Buarque L, Dandara Pereira Gama M, Oliveira FAA. Neurological manifestations as prognostic factors in COVID-19: a retrospective cohort study. Acta Neurol Belg 2022; 122:725-733. [PMID: 35060095 PMCID: PMC8776373 DOI: 10.1007/s13760-021-01851-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/09/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neurological manifestations are frequent during COVID-19 but have been poorly studied as prognostic markers of COVID-19. OBJECTIVES The aim of this study was to assess whether neurological manifestations are associated with a poor prognosis of COVID-19, and which patient and COVID-19 characteristics were associated with encephalopathy. METHODS This was a retrospective cohort study and included patients admitted with COVID-19 in four hospitals from Recife, Brazil. Data were collected by reviewing medical records. RESULTS 613 were included; 54.6% were male, the median age was 54 (41-68) years, 26.4% required mechanical ventilation, and 24.1% died. The neurological symptoms presented were: myalgia (25.6%), headache (22%), fatigue (22%), drowsiness (16%), anosmia (14%), disorientation (8.8%), ageusia (7.3%), seizures (2.8%), and dizziness (1.5%). Twelve patients (2%) had strokes (ischemic strokes: 9) and 149 (24.3%), encephalopathy. Older age, a prolonged hospitalization, diabetes mellitus, a previous history of stroke and having epileptic seizures during hospitalization were significantly associated with the occurrence of encephalopathy. Older age, smoking and requiring mechanical ventilation were associated with prolonged hospitalization. Older patients, those requiring mechanical ventilation and those with encephalopathy presented a significantly higher risk, while those who had anosmia presented a significantly lower risk of dying. CONCLUSIONS Neurological symptoms are frequent among patients with COVID-19. Encephalopathy was the most frequent neurological complication and was associated with a higher mortality. Those with anosmia had a lower mortality.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Rua General Joaquim Inacio, 830, Sala 1412, Edf The Plaza Business Center, Recife, PE, CEP: 50070-495, Brazil.
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil.
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
| | | | | | | | | | - Felipe Araújo Andrade Oliveira
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Rua General Joaquim Inacio, 830, Sala 1412, Edf The Plaza Business Center, Recife, PE, CEP: 50070-495, Brazil
- Real Hospital Português de Beneficência de Pernambuco, Recife, Brazil
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22
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Sampaio Rocha‐Filho PA. Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management. Headache 2022; 62:650-656. [PMID: 35545780 PMCID: PMC9348060 DOI: 10.1111/head.14319] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022]
Abstract
Objective Background Method Results Conclusions
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Affiliation(s)
- Pedro Augusto Sampaio Rocha‐Filho
- Division of Neuropsychiatry Centro de Ciências Médicas Universidade Federal de Pernambuco (UFPE) Recife Brazil
- Hospital Universitario Oswaldo Cruz Universidade de Pernambuco Recife Brazil
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23
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Moeed A, Huda Z. COVID-19 Clinical Features and Recovery Time: Factors Affecting the Outcome [Letter]. Infect Drug Resist 2022; 15:1459-1460. [PMID: 35401009 PMCID: PMC8992738 DOI: 10.2147/idr.s367741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
- Correspondence: Abdul Moeed, Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan, Tel +92-3061159372, Email
| | - Zunera Huda
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
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24
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Aparisi Á, Ybarra-Falcón C, Iglesias-Echeverría C, García-Gómez M, Marcos-Mangas M, Valle-Peñacoba G, Carrasco-Moraleja M, Fernández-de-las-Peñas C, Guerrero ÁL, García-Azorín D. Cardio-Pulmonary Dysfunction Evaluation in Patients with Persistent Post-COVID-19 Headache. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073961. [PMID: 35409644 PMCID: PMC8997887 DOI: 10.3390/ijerph19073961] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
Background (1): Headache is a prevalent symptom experienced during ongoing SARS-CoV-2 infection, but also weeks after recovery. Whether cardio-pulmonary dysfunction contributes causally to headache persistence is unknown. Methods (2): We conducted a case-control analysis nested in a prospective cohort study. Individuals were recruited from August 2020 to December 2020. Patients were grouped according to the presence or absence of long-COVID headache for three months after COVID-19 resolution. We compared demographic data, clinical variables, cardio-pulmonary laboratory biomarkers, quality of life, and cardio-pulmonary function between groups. Results (3): A cohort of 70 COVID-19 patients was evaluated. Patients with headaches (n = 10; 14.3%) were more frequently female (100% vs. 58.4%; p = 0.011) and younger (46.9 ± 8.45 vs. 56.13 ± 12 years; p = 0.023). No between-group differences in laboratory analysis, resting echocardiography, cardio-pulmonary exercise test, or pulmonary function tests were observed. Conclusion (4): In this exploratory study, no significant differences in cardio-pulmonary dysfunction were observed between patients with and without long-COVID headache during mid-term follow-up.
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Affiliation(s)
- Álvaro Aparisi
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Cristina Ybarra-Falcón
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (C.Y.-F.); (C.I.-E.); (M.G.-G.); (M.M.-M.); (M.C.-M.)
| | - Carolina Iglesias-Echeverría
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (C.Y.-F.); (C.I.-E.); (M.G.-G.); (M.M.-M.); (M.C.-M.)
| | - Mario García-Gómez
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (C.Y.-F.); (C.I.-E.); (M.G.-G.); (M.M.-M.); (M.C.-M.)
| | - Marta Marcos-Mangas
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (C.Y.-F.); (C.I.-E.); (M.G.-G.); (M.M.-M.); (M.C.-M.)
| | - Gonzalo Valle-Peñacoba
- Department of Neurology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (G.V.-P.); (Á.L.G.); (D.G.-A.)
| | - Manuel Carrasco-Moraleja
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (C.Y.-F.); (C.I.-E.); (M.G.-G.); (M.M.-M.); (M.C.-M.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-91-488-88-84; Fax: +34-91-488-89-57
| | - Ángel L. Guerrero
- Department of Neurology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (G.V.-P.); (Á.L.G.); (D.G.-A.)
| | - David García-Azorín
- Department of Neurology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain; (G.V.-P.); (Á.L.G.); (D.G.-A.)
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25
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Laza R, Dragomir C, Musta VF, Lazureanu VE, Nicolescu ND, Marinescu AR, Paczeyka R, Porosnicu TM, Bica-Porfir V, Laitin SMD, Dragomir I, Ilie C, Baditoiu LM. Analysis of Deaths and Favorable Developments of Patients with SARS-CoV-2 Hospitalized in the Largest Hospital for Infectious Diseases and Pneumo-Phthisiology in the West of the Country. Int J Gen Med 2022; 15:3417-3431. [PMID: 35378919 PMCID: PMC8976499 DOI: 10.2147/ijgm.s359483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/16/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients. Patients and Methods In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test. Results The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94–487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01–1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24–1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38–4.35], p = 0.000; O2 saturation HR = 0.98 [0.96–0.99], p = 0.043; serum creatinine HR = 1.23 [1.08–1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42–6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97–7.33], p < 0.001; heart damage HR = 16.76 [1.49–188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92–208.19], p < 0.001. Conclusion Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.
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Affiliation(s)
- Ruxandra Laza
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Cristina Dragomir
- Doctoral School, University of Medicine and Pharmacy “Victor Babes”, Timisoara, 300041, Romania
| | - Virgil Filaret Musta
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Narcisa Daniela Nicolescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
- Doctoral School, University of Medicine and Pharmacy “Victor Babes”, Timisoara, 300041, Romania
| | - Roxana Paczeyka
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Tamara Mirela Porosnicu
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
- Doctoral School, University of Medicine and Pharmacy “Victor Babes”, Timisoara, 300041, Romania
| | - Valerica Bica-Porfir
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
| | - Sorina Maria Denisa Laitin
- Clinical Hospital of Infectious Diseases and Pneumophtisiology “Doctor Victor Babes”, Timisoara, 300310, Romania
- Department XIII, Discipline of Epidemiology, University of Medicine and Pharmacy “Victor Babes”, Timisoara, 300041, Romania
| | - Ion Dragomir
- Individual Family Medical Office, Ostroveni, Dolj, Romania
| | - Constantin Ilie
- Department XII, Discipline of Neonatology and Childcare, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Luminita Mirela Baditoiu
- Department XIII, Discipline of Epidemiology, University of Medicine and Pharmacy “Victor Babes”, Timisoara, 300041, Romania
- Multidisciplinary Research Centre on Antimicrobial Resistance, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Correspondence: Luminita Mirela Baditoiu, Cristina Dragomir Department XIII, Discipline of Epidemiology, Victor Babes University of Medicine and Pharmacy; Doctoral School, University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, Timisoara, 300041, Romania, Tel +40727746440; +40753036306, Email ;
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Garcia-Azorin D, Layos-Romero A, Porta-Etessam J, Membrilla JA, Caronna E, Gonzalez-Martinez A, Mencia ÁS, Segura T, Gonzalez-García N, Díaz-de-Terán J, Gallardo VJ, Gago-Veiga AB, Ballvé A, Trigo López J, Sastre-Real M, Llauradó A, Cornejo A, de Lorenzo Í, Guerrero-Peral Á, Pozo-Rosich P. Post-COVID-19 persistent headache: A multicentric 9-months follow-up study of 905 patients. Cephalalgia 2022; 42:804-809. [PMID: 35166156 DOI: 10.1177/03331024211068074] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Headache is a frequent symptoms of coronavirus disease 2019 (COVID-19). Its long-term evolution remains unknown. We aim to evaluate the long-term duration of headache in patients that presented headache during the acute phase of COVID-19. METHODS This is a post-hoc multicenter ambisective study including patients from six different third-level hospitals between 1 March and 27 April 2020. Patients completed 9 months of neurological follow-up. RESULTS We included 905 patients. Their median age was 51 (IQR 45-65), 66.5% were female, and 52.7% had a prior history of primary headache. The median duration of headache was 14 (6-39) days; however, the headache persisted after 3 months in 19.0% (95% CI: 16.5-21.8%) and after 9 months in 16.0% (95% confidence interval: 13.7-18.7%). Headache intensity during the acute phase was associated with a more prolonged duration of headache (Hazard ratio 0.655; 95% confidence interval: 0.582-0.737). CONCLUSION The median duration of headache was 2 weeks, but in approximately a fifth of patients it became persistent and followed a chronic daily pattern.
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Affiliation(s)
- David Garcia-Azorin
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | | | - Jesús Porta-Etessam
- Headache Unit, Department of Neurology, Hospital San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Javier A Membrilla
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Álvaro Sierra Mencia
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | - Tomás Segura
- Department of Neurology, Hospital General de Albacete, Albacete, Spain
| | - Nuria Gonzalez-García
- Headache Unit, Department of Neurology, Hospital San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Díaz-de-Terán
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Victor J Gallardo
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Alejandro Ballvé
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Javier Trigo López
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | - María Sastre-Real
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Arnau Llauradó
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Cornejo
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Íñigo de Lorenzo
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Ángel Guerrero-Peral
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
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Shirazi FM, Mirzaei R, Nakhaee S, Nejatian A, Ghafari S, Mehrpour O. Repurposing the drug, ivermectin, in COVID-19: toxicological points of view. Eur J Med Res 2022; 27:21. [PMID: 35123559 PMCID: PMC8817475 DOI: 10.1186/s40001-022-00645-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/23/2022] [Indexed: 12/15/2022] Open
Abstract
The global COVID-19 pandemic has affected the world’s population by causing changes in behavior, such as social distancing, masking, restricting people’s movement, and evaluating existing medication as potential therapies. Many pre-existing medications such as tocilizumab, ivermectin, colchicine, interferon, and steroids have been evaluated for being repurposed to use for the treatment of COVID-19. None of these agents have been effective except for steroids and, to a lesser degree, tocilizumab. Ivermectin has been one of the suggested repurposed medications which exhibit an in vitro inhibitory activity on SARS-CoV-2 replication. The most recommended dose of ivermectin for the treatment of COVID-19 is 150–200 µg/kg twice daily. As ivermectin adoption for COVID-19 increased, the Food and Drug Administration (FDA) issued a warning on its use during the pandemic. However, the drug remains of interest to clinicians and has shown some promise in observational studies. This narrative reviews the toxicological profile and some potential therapeutic effects of ivermectin. Based on the current dose recommendation, ivermectin appears to be safe with minimum side effects. However, serious questions remain about the effectiveness of this drug in the treatment of patients with COVID-19.
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Sampaio Rocha-Filho PA, Albuquerque PM, Carvalho LCLS, Dandara Pereira Gama M, Magalhães JE. Headache, anosmia, ageusia and other neurological symptoms in COVID-19: a cross-sectional study. J Headache Pain 2022; 23:2. [PMID: 34979899 PMCID: PMC8721484 DOI: 10.1186/s10194-021-01367-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background Neurological symptoms are frequent among patients with COVID-19. Little is known regarding the repercussions of neurological symptoms for patients and how these symptoms are related to one another. Objectives To determine whether there is an association between the neurological symptoms in patients with COVID-19, and to characterize the headache. Method This was a cross-sectional study. All hospital inpatients and health workers at the Hospital Universitario Oswaldo Cruz with a PCR-confirmed COVID-19 infection between March and June 2020 were considered for the study and were interviewed by telephone at least 2-months after the acute phase of the disease. These patients were identified by the hospital epidemiological surveillance department. A semi-structured questionnaire was used containing sociodemographic and clinical data and the ID-Migraine. Results A total of 288 patients was interviewed; 53.1% were male; with a median age of 49.9 (41.5–60.5) years; 91.7% presented some neurological symptom; 22.2% reported some neurological symptom as the symptom that troubled them most during COVID-19. Neurological symptoms were: ageusia (69.8%), headache (69.1%), anosmia (67%), myalgia (44.4%), drowsiness (37.2%), agitation (20.8%); mental confusion (14.9%), syncope (4.9%) and epileptic seizures (2.8%). Females, those who presented with fever, sore throat, anosmia/ageusia and myalgia also presented significantly more with headache (logistic regression). The most frequent headache phenotype was a non-migraine phenotype, was of severe intensity and differed from previous headaches. This persisted for more than 30 days in 18% and for more than 90 days in 10% of patients. Thirteen percent of those with anosmia and 11% with ageusia continued with these complaints after more than 90 days of the acute phase of the disease. Aged over 50 years, agitation and epileptic seizures were significantly associated with mental confusion (logistic regression). Conclusion Headache is frequent in COVID-19, is associated with other symptoms such as fever, sore throat, anosmia, ageusia, and myalgia, and may persist beyond the acute phase of the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01367-8.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Av. da Engenharia, 531-611, Recife, PE, 50730-120, Brazil. .,Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil.
| | - Pedro Mota Albuquerque
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Av. da Engenharia, 531-611, Recife, PE, 50730-120, Brazil
| | | | - Mylana Dandara Pereira Gama
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil
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Okada S, Tomita K, Inui G, Ikeuchi T, Touge H, Hasegawa J, Yamasaki A. Predictive Model for Adverse Events and Immune Response Based on the Production of Antibodies After the Second-Dose of the BNT162b2 mRNA Vaccine. Yonago Acta Med 2022; 65:63-69. [DOI: 10.33160/yam.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/05/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Shinichi Okada
- Department of Pediatrics, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Katsuyuki Tomita
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Genki Inui
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Tomoyuki Ikeuchi
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Hirokazu Touge
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Junichi Hasegawa
- Department of Internal Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-0006, Japan
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Cavallieri F, Sellner J, Zedde M, Moro E. Neurologic complications of coronavirus and other respiratory viral infections. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:331-358. [PMID: 36031313 PMCID: PMC9418023 DOI: 10.1016/b978-0-323-91532-8.00004-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In humans, several respiratory viruses can have neurologic implications affecting both central and peripheral nervous system. Neurologic manifestations can be linked to viral neurotropism and/or indirect effects of the infection due to endothelitis with vascular damage and ischemia, hypercoagulation state with thrombosis and hemorrhages, systemic inflammatory response, autoimmune reactions, and other damages. Among these respiratory viruses, recent and huge attention has been given to the coronaviruses, especially the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in 2020. Besides the common respiratory symptoms and the lung tropism of SARS-CoV-2 (COVID-19), neurologic manifestations are not rare and often present in the severe forms of the infection. The most common acute and subacute symptoms and signs include headache, fatigue, myalgia, anosmia, ageusia, sleep disturbances, whereas clinical syndromes include mainly encephalopathy, ischemic stroke, seizures, and autoimmune peripheral neuropathies. Although the pathogenetic mechanisms of COVID-19 in the various acute neurologic manifestations are partially understood, little is known about long-term consequences of the infection. These consequences concern both the so-called long-COVID (characterized by the persistence of neurological manifestations after the resolution of the acute viral phase), and the onset of new neurological symptoms that may be linked to the previous infection.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France,Correspondence to: Elena Moro, Service de neurologie, CHU de Grenoble (Hôpital Nord), Boulevard de la Chantourne, 38043 La Tronche, France. Tel: + 33-4-76-76-94-52, Fax: +33-4-76-76-56-31
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Sharma M, Menon B. Headache incidence and characteristics in COVID-19 patients: A hospital-based study. Ann Indian Acad Neurol 2022; 25:88-91. [PMID: 35342235 PMCID: PMC8954331 DOI: 10.4103/aian.aian_244_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Headache is one of the commonly reported symptoms of coronavirus disease-2019 (COVID-19) illness. A number of studies have been done so far focusing on headache associated with COVID-19 with variable incidence and characteristics. Material and Methods: This study is a prospective study conducted on 120 patients with confirmed COVID-19 illness. Critically ill and ventilated patients were excluded. Demographic data, COVID illness symptom profile, headache characteristics were documented. Patients were followed up at 2 weeks and 4 weeks. For the statistical analysis, Statistical Package for the Social Sciences (SPSS), version 24.0 was used. Results: 120 COVID-19 positive cases were included in the study with a mean age of 54.59 ± 14.89 years (range 21-84 years) with male-to-female ratio of 3:2. 78.33% (94) of patients had various comorbidities. 43.33% (52) cases were diabetic. The presenting symptoms were fever (65%), cough (53.33%), shortness of breath (35%) and myalgia (31.66%). 26 (21.66%) patients reported headache during the COVID illness. 18 (15%) cases had headache attributed as secondary to COVID-19 illness. Out of them, 12 cases were new onset with no past history of headache and 6 cases had a significant change in previous headache episodes. COVID-19 illness precipitated headache episodes similar to past headache type in 8 cases. Headache was the presenting symptom in 8 (6.66%) patients with COVID-19 being detected in the regular hospital screening protocol. Conclusion: Headache was a common symptom in COVID-19 patients. New onset headaches or change in past headache type in patients in the setting of ongoing pandemic should be screened for COVID-19.
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Paré B, Rozendaal M, Morin S, Kaufmann L, Simpson SM, Poujol R, Mostefai F, Grenier JC, Xing H, Sanchez M, Yechouron A, Racette R, Hussin JG, Wolf G, Pavlov I, Smith MA. Patient health records and whole viral genomes from an early SARS-CoV-2 outbreak in a Quebec hospital reveal features associated with favorable outcomes. PLoS One 2021; 16:e0260714. [PMID: 34855869 PMCID: PMC8638998 DOI: 10.1371/journal.pone.0260714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/15/2021] [Indexed: 12/25/2022] Open
Abstract
The first confirmed case of COVID-19 in Quebec, Canada, occurred at Verdun Hospital on February 25, 2020. A month later, a localized outbreak was observed at this hospital. We performed tiled amplicon whole genome nanopore sequencing on nasopharyngeal swabs from all SARS-CoV-2 positive samples from 31 March to 17 April 2020 in 2 local hospitals to assess viral diversity (unknown at the time in Quebec) and potential associations with clinical outcomes. We report 264 viral genomes from 242 individuals-both staff and patients-with associated clinical features and outcomes, as well as longitudinal samples and technical replicates. Viral lineage assessment identified multiple subclades in both hospitals, with a predominant subclade in the Verdun outbreak, indicative of hospital-acquired transmission. Dimensionality reduction identified two subclades with mutations of clinical interest, namely in the Spike protein, that evaded supervised lineage assignment methods-including Pangolin and NextClade supervised lineage assignment tools. We also report that certain symptoms (headache, myalgia and sore throat) are significantly associated with favorable patient outcomes. Our findings demonstrate the strength of unsupervised, data-driven analyses whilst suggesting that caution should be used when employing supervised genomic workflows, particularly during the early stages of a pandemic.
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Affiliation(s)
- Bastien Paré
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montreal, Quebec, Canada
| | | | - Sacha Morin
- Department of Computer Science and Operational Research, Université de Montréal, Montreal, Quebec, Canada
- Mila—Quebec AI Institute, Montreal, Quebec, Canada
| | - Léa Kaufmann
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montreal, Quebec, Canada
| | | | | | - Fatima Mostefai
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montreal, Quebec, Canada
- Montreal Heart Institute, Montréal, Quebec, Canada
| | | | - Henry Xing
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Miguelle Sanchez
- Department of Microbiology and Infectious Diseases, Hôpital de Verdun, Montreal, Quebec, Canada
| | - Ariane Yechouron
- Department of Microbiology and Infectious Diseases, Hôpital de Verdun, Montreal, Quebec, Canada
| | - Ronald Racette
- Department of Emergency Medicine, Hôpital de Verdun, Montreal, Quebec, Canada
| | - Julie G. Hussin
- Montreal Heart Institute, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Guy Wolf
- Mila—Quebec AI Institute, Montreal, Quebec, Canada
- Department of Mathematics and Statistics, Université de Montréal, Montreal, Quebec, Canada
| | - Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montreal, Quebec, Canada
| | - Martin A. Smith
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montreal, Quebec, Canada
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Abstract
Purpose of Review Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. Recent Findings The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Summary Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.
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Bistaraki A, Roussos S, Tsiodras S, Sypsa V. Age-dependent effects on infectivity and susceptibility to SARS-CoV-2 infection: results from nationwide contact tracing data in Greece. Infect Dis (Lond) 2021; 54:186-195. [PMID: 34743646 DOI: 10.1080/23744235.2021.1995627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Understanding the factors that affect the transmissibility of SARS-CoV-2 remains important to keep transmission low and maximize the health benefits of vaccination. We assessed the factors associated with the transmissibility of SARS-CoV-2 based on contact tracing data. METHODS From 1 October to 9 December 2020, 29,385 laboratory-confirmed SARS-CoV-2 cases (index cases, i.e. the first identified laboratory-confirmed cases or with the earliest symptom onset in a setting) and 64,608 traced contacts were identified in Greece. We assessed the prevalence of symptoms in cases, calculated secondary attack rates and assessed factors associated with infectivity and susceptibility to infection. RESULTS There were 11,232 contacts secondarily infected (secondary attack rate: 17.4%, 95% CI:17.0-17.8). Contacts aged 0-11 and 12-17 years were less susceptible to infection than adults 65 years or older (odds ratio (OR) [95% CI]: 0.28 [0.26-0.32] and 0.44 [0.40-0.49], respectively). Index cases aged 65 years or older were more likely to infect their contacts than other adults or children/adolescents. The odds of infection [95% CI] were higher in contacts exposed within the household (1.71 [1.59-1.85] vs. other) and in cases with cough (1.17 [1.11-1.25] vs. no cough). There was an interaction between the age of the index and the age of the contact with contacts 65 years or older having a higher probability of infection when exposed to cases of similar age than to children. CONCLUSIONS Our findings highlight the role of age and age mixing in infectivity and susceptibility to SARS-CoV-2 infection. Precautions are necessary for individuals 65 or older as they have higher infectivity and susceptibility in contact with their peers.
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Affiliation(s)
- Angeliki Bistaraki
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Fernández-de-Las-Peñas C, Navarro-Santana M, Gómez-Mayordomo V, Cuadrado ML, García-Azorín D, Arendt-Nielsen L, Plaza-Manzano G. Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: A meta-analysis of the current literature. Eur J Neurol 2021; 28:3820-3825. [PMID: 34327787 PMCID: PMC8444899 DOI: 10.1111/ene.15040] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
Background Headache is identified as a common post‐COVID sequela experienced by COVID‐19 survivors. The aim of this pooled analysis was to synthesize the prevalence of post‐COVID headache in hospitalized and non‐hospitalized patients recovering from SARS‐CoV‐2 infection. Methods MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers, were searched up to 31 May 2021. Studies or preprints providing data on post‐COVID headache were included. The methodological quality of the studies was assessed using the Newcastle‐Ottawa Scale. Random effects models were used for meta‐analytical pooled prevalence of post‐COVID headache. Data synthesis was categorized at hospital admission/symptoms' onset, and at 30, 60, 90, and ≥180 days afterwards. Results From 9573 studies identified, 28 peer‐reviewed studies and 7 preprints were included. The sample was 28,438 COVID‐19 survivors (12,307 females; mean age: 46.6, SD: 17.45 years). The methodological quality was high in 45% of the studies. The overall prevalence of post‐COVID headache was 47.1% (95% CI 35.8–58.6) at onset or hospital admission, 10.2% (95% CI 5.4–18.5) at 30 days, 16.5% (95% CI 5.6–39.7) at 60 days, 10.6% (95% CI 4.7–22.3) at 90 days, and 8.4% (95% CI 4.6–14.8) at ≥180 days after onset/hospital discharge. Headache as a symptom at the acute phase was more prevalent in non‐hospitalized (57.97%) than in hospitalized (31.11%) patients. Time trend analysis showed a decreased prevalence from the acute symptoms’ onset to all post‐COVID follow‐up periods which was maintained afterwards. Conclusion This meta‐analysis found that the prevalence of post‐COVID headache ranged from 8% to 15% during the first 6 months after SARS‐CoV‐2 infection.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain.,Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marcos Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep 2021; 11:14674. [PMID: 34282206 PMCID: PMC8290038 DOI: 10.1038/s41598-021-94220-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023] Open
Abstract
To estimate the frequency of headache in patients with confirmed COVID-19 and characterize the phenotype of headache attributed to COVID-19, comparing patients depending on the need of hospitalization and sex, an observational study was done. We systematically screened all eligible patients from a reference population of 261,431 between March 8 (first case) and April 11, 2020. A physician administered a survey assessing demographic and clinical data and the phenotype of the headache. During the study period, 2194 patients out of the population at risk were diagnosed with COVID-19. Headache was described by 514/2194 patients (23.4%, 95% CI 21.7–25.3%), including 383/1614 (23.7%) outpatients and 131/580 (22.6%) inpatients. The headache phenotype was studied in detail in 458 patients (mean age, 51 years; 72% female; prior history of headache, 49%). Headache was the most frequent first symptom of COVID-19. Median headache onset was within 24 h, median duration was 7 days and persisted after 1 month in 13% of patients. Pain was bilateral (80%), predominantly frontal (71%), with pressing quality (75%), of severe intensity. Systemic symptoms were present in 98% of patients. Headache frequency and phenotype was similar in patients with and without need for hospitalization and when comparing male and female patients, being more intense in females. Trial registration: This study was supported by the Institute of Health Carlos III (ISCIII), code 07.04.467804.74011 and Regional Health Administration, Gerencia Regional de Salud, Castilla y Leon (GRS: 2289/A/2020).
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Affiliation(s)
- David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal N° 3, 47003, Valladolid, Spain.
| | - Álvaro Sierra
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal N° 3, 47003, Valladolid, Spain
| | - Javier Trigo
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal N° 3, 47003, Valladolid, Spain
| | - Ana Alberdi
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - María Blanco
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | | | - Ana Cornejo
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Miguel Cubero
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Ana Gil
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | | | | | | | - Carol Montilla
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Marta Mora
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Gabriela Núñez
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Marina Paniagua
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Carolina Pérez
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - María Rojas
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Marta Ruiz
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Leticia Sierra
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | | | - Ángel Luis Guerrero Peral
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal N° 3, 47003, Valladolid, Spain.,Department of Medicine and toxicology, University of Valladolid, Valladolid, Spain
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Fernández-de-las-Peñas C, Gómez-Mayordomo V, García-Azorín D, Palacios-Ceña D, Florencio LL, Guerrero AL, Hernández-Barrera V, Cuadrado ML. Previous History of Migraine Is Associated With Fatigue, but Not Headache, as Long-Term Post-COVID Symptom After Severe Acute Respiratory SARS-CoV-2 Infection: A Case-Control Study. Front Hum Neurosci 2021; 15:678472. [PMID: 34295230 PMCID: PMC8290894 DOI: 10.3389/fnhum.2021.678472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the presence of post-coronavirus disease (COVID) symptoms. BACKGROUND No study has investigated the role of migraine as a risk factor for development of post-COVID symptoms. METHODS A case-control study including individuals hospitalised during the first wave of the pandemic (from February 20 to May 31, 2020) was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed. RESULTS Overall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months (SD 0.6) after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater (OR 1.70, 95% CI 1.29-2.25, P < 0.001) than in the non-migraine group. Fatigue was significantly more prevalent (OR 2.89, 95% CI 1.32-6.32, P = 0.008) in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected. CONCLUSION Patients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Angel L. Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | - María L. Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study. J Clin Immunol 2021; 41:1479-1489. [PMID: 34164762 PMCID: PMC8221557 DOI: 10.1007/s10875-021-01066-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. METHODS We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. RESULTS 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. CONCLUSION The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).
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Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, García-Azorín D, Hernández-Barrera V, Arendt-Nielsen L. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia 2021; 41:1332-1341. [PMID: 34134526 PMCID: PMC8212025 DOI: 10.1177/03331024211020404] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors. Methods A case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Results Overall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen. Conclusion Headache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Angel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | | | - Lars Arendt-Nielsen
- CNAP, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Paré B, Rozendaal M, Morin S, Poujol R, Mostefai F, Grenier JC, Kaufmann L, Xing H, Sanchez M, Yechouron A, Racette R, Hussin J, Wolf G, Pavlov I, Smith MA. Genomic epidemiology and associated clinical outcomes of a SARS-CoV-2 outbreak in a general adult hospital in Quebec. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34100030 PMCID: PMC8183041 DOI: 10.1101/2021.05.29.21257760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The first confirmed case of COVID-19 in Quebec, Canada, occurred at Verdun Hospital on February 25, 2020. A month later, a localized outbreak was observed at this hospital. We performed tiled amplicon whole genome nanopore sequencing on nasopharyngeal swabs from all SARS-CoV-2 positive samples from 31 March to 17 April 2020 in 2 local hospitals to assess the viral diversity of the outbreak. We report 264 viral genomes from 242 individuals (both staff and patients) with associated clinical features and outcomes, as well as longitudinal samples, technical replicates and the first publicly disseminated SARS-CoV-2 genomes in Quebec. Viral lineage assessment identified multiple subclades in both hospitals, with a predominant subclade in the Verdun outbreak, indicative of hospital-acquired transmission. Dimensionality reduction identified two subclades that evaded supervised lineage assignment methods, including Pangolin, and identified certain symptoms (headache, myalgia and sore throat) that are significantly associated with favorable patient outcomes. We also address certain limitations of standard SARS-CoV-2 bioinformatics procedures, notably when presented with multiple viral haplotypes.
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Garner M, Reith W, Yilmaz U. [COVID-19: neurological manifestations-update : What we know so far]. Radiologe 2021; 61:902-908. [PMID: 34499188 PMCID: PMC8427155 DOI: 10.1007/s00117-021-00907-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 01/09/2023]
Abstract
Beyond pulmonary presentation, COVID-19 infection can manifest with a variety of both acute and chronic neurologic and neuropsychiatric (concomitant) symptoms and diseases. Nonspecific symptoms such as headache, fatigue, olfactory and gustatory disturbance have been reported more frequently, and severe disease such as encephalopathy, encephalitis, and cerebrovascular events have been reported relatively rarely. The heterogeneity of neurologic and neuropsychiatric presentations is large, as well as the range of recorded prevalences. Older patients, pre-existing neurologic and non neurologic comorbidities and severe COVID-19 disease were associated with increased risk of severe neurologic complications and higher in-hospital mortality. Probable neurotropic pathomechanisms of SARS-CoV‑2 have been discussed, but a multifactorial genesis of neurologic/neuropsychiatric symptoms and disease beyond these is likely.
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Affiliation(s)
- Malvina Garner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424 Homburg-Saar, Deutschland
| | - W. Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424 Homburg-Saar, Deutschland
| | - U. Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424 Homburg-Saar, Deutschland
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