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Carvalho LCLS, da Silva PA, Rocha-Filho PAS. Persistent headache and chronic daily headache after COVID-19: a prospective cohort study. Korean J Pain 2024; 37:247-255. [PMID: 38881283 PMCID: PMC11220374 DOI: 10.3344/kjp.24046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/18/2024] Open
Abstract
Background Little is known about the frequency and impact of the persistent headache and about the incidence of chronic daily headache (CDH) after coronavirus disease 2019 (COVID-19). The aim of this prospective cohort study was to assess the incidence, risk factors, characteristics, and impact of CDH in patients with COVID-19. Methods In the first stage, 288 patients were interviewed by telephone after the acute phase of COVID-19. Subsequently, 199 patients who presented headache were reinterviewed at least one year after COVID-19. Headaches that persisted beyond the acute phase of COVID-19 for three or more months and presented frequency ≥ 45 days over the first three months were considered to be CDH. Results One hundred and twenty-three patients were included, 56% were females; median age: 50 years (25th and 75th percentile: 41;58). The headache persisted beyond the acute phase of COVID-19 in 52%, and 20.3% had CDH (95% confidence interval: 13.6-28.2). Individuals who previously had headaches and who had headaches of greater intensity during the acute phase were at higher risk of developing CDH. The group with CDH included more females, greater impact of headache, more persistence of headache beyond the 120th day of COVID-19 and less throbbing headache than did the other individuals whose headache persisted. Conclusions Patients who had COVID-19 had a high incidence of CDH. Previous headache and greater intensity of headache were associated with higher risk of CDH.
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Affiliation(s)
| | - Priscila Aparecida da Silva
- Scientific Initiation Fellowships Institutional Program (CNPq/PROPESQI-UFPE), Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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2
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Dhiman NR, Joshi D, Singh R, Gyanpuri V, Kumar A. Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports. FRONTIERS IN PAIN RESEARCH 2024; 5:1376506. [PMID: 38808005 PMCID: PMC11130372 DOI: 10.3389/fpain.2024.1376506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Background and objectives Post-acute COVID-19 syndrome or "long COVID" affects patients even after the recovery from Covid infection in various ways. Persistent headache or New Daily Persistent Headache (NDPH) is one of such symptoms. In this review, we will discuss about the case-reports of post covid-19 headache- NDPH phenotype both after and in the course of COVID-19 infection. Methods Case reports/studies talked about patients having NDPH around the disease either immediately or late post COVID were included. Data was taken from the source and synthesised on a qualitative basis. Results Literature search showed 3,538 articles, out of which 12 were screened as per the eligibility criteria and finally, 4 case reports on NDPH and Covid-19 were chosen for analysis from the database and by human search. All case reports justify the criteria for acceptability in quality for this systematic review. Conclusion NDPH in and around Covid 19 infection is something that is currently an ingenious debated topic in the scientific community. More case studies should be written and published on the same subject so that a large systematic review could be conducted. Trial Registration Information The review is registered in Prospero with no. Identifier (CRD42022354912). Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912).
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Affiliation(s)
| | - Deepika Joshi
- Department of Neurology, Banaras Hindu University, Varanasi, India
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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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Tana C, Raffaelli B, Souza MNP, de la Torre ER, Massi DG, Kisani N, García-Azorín D, Waliszewska-Prosół M. Health equity, care access and quality in headache - part 1. J Headache Pain 2024; 25:12. [PMID: 38281917 PMCID: PMC10823691 DOI: 10.1186/s10194-024-01712-7] [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: 12/01/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Current definitions of migraine that are based mainly on clinical characteristics do not account for other patient's features such as those related to an impaired quality of life, due to loss of social life and productivity, and the differences related to the geographical distribution of the disease and cultural misconceptions which tend to underestimate migraine as a psychosocial rather than neurobiological disorder.Global differences definition, care access, and health equity for headache disorders, especially migraine are reported in this paper from a collaborative group of the editorial board members of the Journal of Headache and Pain. Other components that affect patients with migraine, in addition to the impact promoted by the migraine symptoms such as stigma and social determinants, are also reported.
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Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache and Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy.
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | - Daniel Gams Massi
- Neurology Unit, Douala General Hospital, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Najib Kisani
- Department of Neurology, Mohammed VI University Hospital, Marrakech, Morocco
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003, Valladolid, Spain
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5
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Carrión-Nessi FS, Ascanio LC, Pineda-Arapé AG, Omaña-Ávila ÓD, Mendoza-Millán DL, Romero SR, Almao-Rivero AB, Camejo-Ávila NA, Gebran-Chedid KJ, Rodriguez-Saavedra CM, Freitas-De Nobrega DC, Castañeda SA, Forero-Peña JL, Delgado-Noguera LA, Meneses-Ramírez LK, Cotuá JC, Rodriguez-Morales AJ, Forero-Peña DA, Paniz-Mondolfi AE. New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study. BMC Infect Dis 2023; 23:877. [PMID: 38097988 PMCID: PMC10722794 DOI: 10.1186/s12879-023-08898-2] [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: 09/16/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes. METHODS We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student's t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson's chi-square and Fisher's exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH. RESULTS Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH. CONCLUSION This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Luis C Ascanio
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Andreína G Pineda-Arapé
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Óscar D Omaña-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniela L Mendoza-Millán
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Sinibaldo R Romero
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Medical Scientist Training Program (MD/PhD), University of Minnesota Medical School, Minneapolis, MN, USA
| | - Abranny B Almao-Rivero
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Natasha A Camejo-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | | | | | - Diana C Freitas-De Nobrega
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Sergio A Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología, Facultad de Ciencias Naturales, Universidad del Rosario (CIMBIUR), Universidad del Rosario, Bogotá, Colombia
| | - José L Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Lourdes A Delgado-Noguera
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Lucianny K Meneses-Ramírez
- "Dr. Francisco Battistini Casalta" Health Sciences School, University of Oriente - Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Juan C Cotuá
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Alfonso J Rodriguez-Morales
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - David A Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela.
| | - Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Muddam MR, Obajeun OA, Abaza A, Jaramillo AP, Sid Idris F, Anis Shaikh H, Vahora I, Moparthi KP, Al Rushaidi MT, Nath TS. Efficacy and Safety of Anti-calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies in Preventing Migraines: A Systematic Review. Cureus 2023; 15:e45560. [PMID: 37868560 PMCID: PMC10586710 DOI: 10.7759/cureus.45560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
The neuropeptide calcitonin gene-related peptide (CGRP) is an essential pathophysiological treatment for migraines. A unique class of medications called CGRP monoclonal antibodies target CGRP and its receptor and have demonstrated promising benefits in the treatment and prevention of migraines. This study sought to identify and assess the quality of existing systematic reviews about the effectiveness of CGRP antibodies for preventing migraines, as well as systematically review and synthesize the evidence on these topics. This included the four Food and Drug Administration (FDA)-approved medications erenumab, galcanezumab, fremanezumab, and eptinezumab. The effectiveness and safety of these monoclonal antibodies in preventing migraines should also be examined in light of patient characteristics, and any gaps in the body of knowledge should be noted in order to suggest new lines of investigation. Data gathering included a thorough search of internet databases (PubMed, Cochrane Library, Web of Science, and Scopus) for relevant research released between 2018 and 2023. The findings imply that CGRP monoclonal antibodies are efficient and secure for preventing migraines and may be considered a first-line alternative for treating migraines and drug misuse. The results further imply that combination treatment with CGRP antibodies and onabotulinumtoxinA may enhance the prevention of migraine in adults. With suggestions for more studies to find and address these variables, the significance of genetic and epigenetic factors in the progression of pediatric patients' acute postoperative pain to chronic postsurgical pain is underlined. All four anti-CGRP monoclonal antibodies, erenumab, fremanezumab, galcanezumab, and eptinezumab, were shown to be safe and effective for the prevention of migraine when the research additionally looked at their individual effectiveness and safety. Additionally, the study discovered considerable variances in effectiveness amongst various groups. However, further investigation is required to establish the best time and dosage and the effect of patient characteristics on the effectiveness and safety of these medications.
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Affiliation(s)
- Meghana Reddy Muddam
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Omobolanle A Obajeun
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abdelrahman Abaza
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arturo P Jaramillo
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Faten Sid Idris
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Humna Anis Shaikh
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ilma Vahora
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kiran Prasad Moparthi
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Majdah T Al Rushaidi
- Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tuheen Sankar Nath
- Surgical Oncology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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7
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New-onset headache following COVID-19: An Italian multicentre case series. J Neurol Sci 2023; 446:120591. [PMID: 36807975 PMCID: PMC9931424 DOI: 10.1016/j.jns.2023.120591] [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] [Received: 11/22/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with new-onset headache following SARS-CoV-2 infection. BACKGROUND SARS-CoV-2 infection leads to several neurological manifestations, and headache is a frequent and disabling symptom, both exacerbating pre-existing headache syndromes and causing new-onset ones. METHODS Patients with new-onset headache after SARS-CoV-2 infection with consent to participate were included, while those ones with previous headaches were excluded. The temporal latency of headache after infection, pain characteristics, and concomitant symptoms were analysed. Moreover, the efficacy of acute and preventive medications was explored. RESULTS Eleven females (median age 37.0 [10.0-60.0] years old) were included. In most cases, headache onset occurred with the infection, the location of pain varied, and the quality was either pulsating or tightening. Headache was persistent and daily in 8 patients (72.7%), while it occurred in episodes in the remaining subjects. Baseline diagnoses were new daily persistent headache (36.4%), probable new daily persistent headache (36.4%), probable migraine (9.1%), and migraine-like headache secondary to COVID-19 (18.2%). Ten patients received one or more preventive treatments and six of them showed an improvement. CONCLUSION New-onset headache following COVID-19 is a heterogenous condition with uncertain pathogenesis. This type of headache can become persistent and severe, with a wide spectrum of manifestations (new daily persistent headache being the most represented one) and variable response to treatment.
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8
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Song J, Jing Q, Zhu E, Liu Q, Fei M, Zhang H, An G, Cao S, Tang J, Xu G, Liu Y, Ai Z, Tao Y, Li C, Xiong L. Alterations in smell or taste in individuals infected with SARS-CoV-2 during periods of Omicron variant dominance. Int J Infect Dis 2023; 128:278-284. [PMID: 36657518 PMCID: PMC9840980 DOI: 10.1016/j.ijid.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To characterize the prevalence, severity, correlation with initial symptoms, and role of vaccination in patients with COVID-19 with smell or taste alterations (STAs). METHODS We conducted an observational study of patients infected with SARS-CoV-2 Omicron admitted to three hospitals between May 17 and June 16, 2022. The olfactory and gustatory functions were evaluated using the taste and smell survey and the numerical visual analog scale at two time points. RESULTS The T1 and T2 time point assessments were completed by 688 and 385 participants, respectively. The prevalence of STAs at two time points was 41.3% vs 42.6%. Furthermore, no difference existed in the severity distribution of taste and smell survey, smell, or taste visual analog scale scores between the groups. Patients with initial symptoms of headache (P = 0.03) and muscle pain (P = 0.04) were more likely to develop STAs, whereas higher education; three-dose vaccination; no symptoms yet; or initial symptoms of cough, throat discomfort, and fever demonstrated protective effects, and the results were statistically significant. CONCLUSION The prevalence of STAs did not decrease significantly during the Omicron dominance, but the severity was reduced, and vaccination demonstrated a protective effect. In addition, the findings suggest that the presence of STAs is likely to be an important indicator of viral invasion of the nervous system.
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Affiliation(s)
- Jian Song
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Enzhao Zhu
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Qidong Liu
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopedic Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Miaomiao Fei
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Hui Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Guanghui An
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Silu Cao
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Jinxuan Tang
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Guanghui Xu
- Department of Spine Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yi Liu
- Department of Nursing, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Yingna Tao
- Department of Traditional Chinese Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Cheng Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China.
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation Shanghai, China; Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China.
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Houben R. Reduced frequency of migraine attacks following coronavirus disease 2019: a case report. J Med Case Rep 2023; 17:62. [PMID: 36810289 PMCID: PMC9943734 DOI: 10.1186/s13256-023-03795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/29/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is a virus affecting different organs and causing a wide variety and severity of symptoms. Headache as well as loss of smell and taste are the most frequently reported neurological manifestations of coronavirus disease 2019 induced by severe acute respiratory syndrome coronavirus 2. Here we report on a patient with chronic migraine and medication overuse headache, who experienced remarkable mitigation of migraine following coronavirus disease 2019. CASE PRESENTATION For many years prior to the severe acute respiratory syndrome coronavirus 2 infection, a 57-year-old Caucasian male suffered from very frequent migraine attacks and for control of headaches he had been taking triptans almost daily. In the 16-month period before the outbreak of coronavirus disease 2019, triptan was taken 98% of the days with only a 21-day prednisolone-supported triptan holiday, which, however, had no longer-lasting consequences on migraine frequency. Upon severe acute respiratory syndrome coronavirus 2 infection, the patient developed only mild symptoms including fever, fatigue, and headache. Directly following recovery from coronavirus disease 2019, the patient surprisingly experienced a period with largely reduced frequency and severity of migraine attacks. Indeed, during 80 days following coronavirus disease 2019, migraine as well as triptan usage were restricted to only 25% of the days, no longer fulfilling criteria of a chronic migraine and medication overuse headache. CONCLUSION Severe acute respiratory syndrome coronavirus 2 infection might be capable of triggering mitigation of migraine.
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Affiliation(s)
- Roland Houben
- Department of Dermatology, Venereology Und Allergology, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
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Saqib K, Qureshi AS, Butt ZA. COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3262. [PMID: 36833955 PMCID: PMC9962717 DOI: 10.3390/ijerph20043262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an epidemiological and psychological crisis; what it does to the body is quite well known by now, and more research is underway, but the syndemic impact of COVID-19 and mental health on underlying chronic illnesses among the general population is not completely understood. METHODS We carried out a literature review to identify the potential impact of COVID-19 and related mental health issues on underlying comorbidities that could affect the overall health of the population. RESULTS Many available studies have highlighted the impact of COVID-19 on mental health only, but how complex their interaction is in patients with comorbidities and COVID-19, the absolute risks, and how they connect with the interrelated risks in the general population, remain unknown. The COVID-19 pandemic can be recognized as a syndemic due to; synergistic interactions among different diseases and other health conditions, increasing overall illness burden, emergence, spread, and interactions between infectious zoonotic diseases leading to new infectious zoonotic diseases; this is together with social and health interactions leading to increased risks in vulnerable populations and exacerbating clustering of multiple diseases. CONCLUSION There is a need to develop evidence to support appropriate and effective interventions for the overall improvement of health and psychosocial wellbeing of at-risk populations during this pandemic. The syndemic framework is an important framework that can be used to investigate and examine the potential benefits and impact of codesigning COVID-19/non-communicable diseases (NCDs)/mental health programming services which can tackle these epidemics concurrently.
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Affiliation(s)
- Kiran Saqib
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Afaf Saqib Qureshi
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zahid Ahmad Butt
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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11
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Abstract
Background Accumulating evidence suggests various specific triggers may lead to new daily persistent headache (NDPH)-like presentations, suggesting that new daily persistent headache is a heterogenous syndrome, and challenging the concept that new daily persistent headache is a primary headache disorder.Method We searched the PubMed database up to August 2022 for keywords including persistent daily headache with both primary and secondary etiologies. We summarized the literature and provided a narrative review of the clinical presentation, diagnostic work-ups, possible pathophysiology, treatment response, and clinical outcomes.Results and conclusion New daily persistent headache is a controversial but clinically important topic. New daily persistent headache is likely not a single entity but a syndrome with different etiologies. The issue with past studies of new daily persistent headache is that patients with different etiologies/subtypes were pooled together. Different studies may investigate distinct subsets of patients, which renders the inter-study comparison, both positive and negative results, difficult. The identification (and removal) of a specific trigger might provide the opportunity for clinical improvement in certain patients, even when the disease has lasted for months or years. Nonetheless, if there is a specific trigger, it remains unknown or unidentified for a great proportion of the patients. We need to continue to study this unique headache population to better understand underlying pathogenesis and, most importantly, to establish effective treatment strategies that hopefully resolve the continuous cycle of pain.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Todd D Rozen
- Department of Neurology, Mayo Clinic, Florida, USA
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12
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Akıncı T. Post-discharge persistent headache and smell or taste dysfunction after hospitalisation for COVID-19: a single-centre study. Ir J Med Sci 2023; 192:369-375. [PMID: 35304709 PMCID: PMC8933127 DOI: 10.1007/s11845-022-02980-5] [Citation(s) in RCA: 1] [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: 02/20/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the frequency, characteristics, and persistence of headache in coronavirus disease-19 (COVID-19) patients who are hospitalised and to determine if there is a link between headache and smell and/or taste dysfunction. MATERIALS AND METHODS In April and May 2020, patients who were hospitalised due to COVID-19 and had headache complaints were evaluated by a neurologist. In addition to clinical COVID-19 features, the characteristics and course of the patients' headaches were evaluated. The patients were contacted by phone 3 months after they were discharged from the hospital to determine the persistence of their symptoms. RESULTS Eighty-five patients were included in the study, 54.1% were female; the mean age was 47.5 ± 13.9 years (between the ages of 21 and 84). Fifty-four patients (65.3%) presented with smell and/or taste dysfunction, and 14 patients (n = 14, 25.9%) still reported that dysfunction 3 months later. Moreover, 17 (20%) still had headaches 3 months after being discharged from the hospital. Persistent smell/taste disorders were significantly (p < 0.001) more frequent in patients with persistent headaches (59%) compared to those without (6%) (p < 0.001). CONCLUSION In this prospective study in COVID-19 patients presenting with headache upon admission, a correlation between persistent headache 3 months after discharge and persistent smell/taste dysfunction was found that could point to common underlying pathophysiology.
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Affiliation(s)
- Tuba Akıncı
- Department of Neurology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Selimiye, Tıbbiye Cd No:23, 34668 Üsküdar, Istanbul, Turkey.
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13
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Desai DD, Yu SE, Salvatore B, Goldberg Z, Bowers EMR, Moore JA, Phan B, Lee SE. Olfactory and neurological outcomes of SARS-CoV-2 from acute infection to recovery. FRONTIERS IN ALLERGY 2022; 3:1019274. [DOI: 10.3389/falgy.2022.1019274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Educational objectiveTo investigate the impact of SARS-CoV-2 on sinonasal quality of life, olfaction, and cognition at different stages of viral infection and evaluate the association between olfaction and cognition in this population cohort.ObjectivesWhile olfactory dysfunction (OD) is a frequently reported symptom of COVID-19 (98% prevalence), neurocognitive symptoms are becoming more apparent as patients recover from infection. This study aims to address how different stages of infection [active infection (positive PCR test, symptomatic) vs. recovered (7 days post-symptoms)] compared to healthy control patients influence sinonasal quality of life, olfactory function, and cognition.Study designProspective, longitudinal, case-control.MethodsParticipants completed the SNOT-22, University of Pennsylvania Smell Identification Test (UPSIT) and validated cognitive examinations to assess degree of smell loss and neurocognitive function at baseline and at 1 and 3 months for the active group and 3 months for the recovered group. Self-reported olfactory function and overall health metrics were also collected.ResultsThe recovered group had the lowest average UPSIT score of 27.6 compared to 32.7 (active) and 32.6 (healthy control). 80% (n = 24) of the recovered patients and 56.3% (n = 9) of the active patients suffered from smell loss. In follow-up, the active group showed improvement in UPSIT scores while the recovered group scores worsened. In terms of neurocognitive performance, recovered patients had lower processing speed despite an improving UPSIT score.ConclusionSARS-CoV-2 infection was found to impact olfactory function in a delayed fashion with significant impact despite recovery from active infection. Although olfactory function improved, decrements in cognitive processing speed were detected in our cohort.
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14
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Post-COVID Headache: A Literature Review. Curr Pain Headache Rep 2022; 26:835-842. [PMID: 36197571 PMCID: PMC9533267 DOI: 10.1007/s11916-022-01086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review Post-COVID headache may be unique in presentation and mechanism, often presenting as a new phenotype in patients with a history of a primary headache disorder or resulting in a new headache syndrome in those without history of headache. This review presents a description of the literature published focused on post-COVID headache. Additionally, we discuss potential mechanisms and considerations for treatment of post-COVID headache. Recent Findings Headache is one of the most common symptoms of COVID. Common characteristics are revealed when reviewing the phenotypes of headaches that have been described in patients with COVID-19, with most headache phenotypes resembling migraine and new persistent daily headache. Post-COVID headaches are often described as moderate to severe, persistent, and treatment refractory. Summary This review highlights the diversity of presentation of headaches that present as a complication of COVID-19. Treatment of post-COVID headache is challenging, especially in the setting of a pandemic where resources are limited. Clinical Case A 42-year-old woman with a history of episodic migraine without aura presents over video visit with a new headache type. Her typical headaches are predominantly left sided, throbbing in nature, and associated with photophobia and phonophobia. They are fully relieved by oral sumatriptan 2 h after treatment. She describes this new headache as a constant, pulsating, holocephalic pain with no other migrainous features that have been ongoing for 6 weeks. She notes that the headache has been persistent since that time. She has tried over-the-counter acetaminophen and ibuprofen and her typical migraine abortive therapy without relief. She is debilitated and wonders if there is anything that will take the pain away. She shares that she tested positive for COVID-19 about 2 days prior to headache onset and has associated rhinorrhea, anosmia, and ageusia.
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15
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Daripa B, Lucchese S. Unusual Presentation of COVID-19 Headache and Its Possible Pathomechanism. Cureus 2022; 14:e29358. [PMID: 36284805 PMCID: PMC9583707 DOI: 10.7759/cureus.29358] [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] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Headache was the most common neurological symptom during the H1N1 pandemic in 2009 and the most recrudescing symptom of human coronavirus (hCoV) in 2016. Even in this prevailing global coronavirus disease 2019 (COVID-19) pandemic, the main neurological symptom is found to be a headache. Headache phenotypes identified with COVID-19 are largely migraine, tension-type headache, or cough headache located in the frontotemporal or occipital region with wavering intensity and essentially of acute onset. We present two cases of unusual headache phenotypes with COVID-19 infection and attempt to shed light on their pathomechanism. Trigeminal autonomic cephalgia may be a possibility in our case, triggered by the virus itself, either directly or through an indirect path elaborated well in the pathomechanism segment. Severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) binds to angiotensin-converting enzyme 2 (ACE2) located in the peripheral nerve and intracranial vascular endothelium, sensitizing the trigeminovascular system by further interacting with higher cortical pain centers via the thalamic and hypothalamic nuclei, producing pain. CSF analysis along with opening pressure measurement in Case 2 may portray a comprehensive understanding of our patient’s headache. Coupling with the dorsal pons and trigeminal nucleus caudalis (TNC), the hypothalamus could be the supreme generator for an attack. Hypothalamic perturbance could be a possible phenomenon for abnormal headache experiences and requires further validation. The possible COVID-19 pain pathway pathomechanism engaging interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF) alpha aided with a cortical spreading depression disturbing the hypothalamus is also described in this study. Undoubtedly, this pandemic could prove to be a guiding tool for mankind, for a comprehensive understanding of the enigmatic concepts of headaches.
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16
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Mitra J, Kodavati M, Provasek VE, Rao KS, Mitra S, Hamilton DJ, Horner PJ, Vahidy FS, Britz GW, Kent TA, Hegde ML. SARS-CoV-2 and the central nervous system: Emerging insights into hemorrhage-associated neurological consequences and therapeutic considerations. Ageing Res Rev 2022; 80:101687. [PMID: 35843590 PMCID: PMC9288264 DOI: 10.1016/j.arr.2022.101687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 01/27/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to impact our lives by causing widespread illness and death and poses a threat due to the possibility of emerging strains. SARS-CoV-2 targets angiotensin-converting enzyme 2 (ACE2) before entering vital organs of the body, including the brain. Studies have shown systemic inflammation, cellular senescence, and viral toxicity-mediated multi-organ failure occur during infectious periods. However, prognostic investigations suggest that both acute and long-term neurological complications, including predisposition to irreversible neurodegenerative diseases, can be a serious concern for COVID-19 survivors, especially the elderly population. As emerging studies reveal sites of SARS-CoV-2 infection in different parts of the brain, potential causes of chronic lesions including cerebral and deep-brain microbleeds and the likelihood of developing stroke-like pathologies increases, with critical long-term consequences, particularly for individuals with neuropathological and/or age-associated comorbid conditions. Our recent studies linking the blood degradation products to genome instability, leading to cellular senescence and ferroptosis, raise the possibility of similar neurovascular events as a result of SARS-CoV-2 infection. In this review, we discuss the neuropathological consequences of SARS-CoV-2 infection in COVID survivors, focusing on possible hemorrhagic damage in brain cells, its association to aging, and the future directions in developing mechanism-guided therapeutic strategies.
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Affiliation(s)
- Joy Mitra
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Manohar Kodavati
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Vincent E Provasek
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; College of Medicine, Texas A&M University, College Station, TX, USA
| | - K S Rao
- Department of Biotechnology, Koneru Lakshmaiah Education Foundation Deemed to be University, Green Fields, Vaddeswaram, Andhra Pradesh 522502, India
| | - Sankar Mitra
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Dale J Hamilton
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Philip J Horner
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Gavin W Britz
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Thomas A Kent
- Center for Genomics and Precision Medicine, Department of Translational Medical Sciences, Institute of Biosciences and Technology, College of Medicine, Texas A&M Health Science Center, Houston, TX, USA
| | - Muralidhar L Hegde
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA.
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17
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Di Stadio A, D’Ascanio L, Vaira LA, Cantone E, De Luca P, Cingolani C, Motta G, De Riu G, Vitelli F, Spriano G, De Vincentiis M, Camaioni A, La Mantia I, Ferreli F, Brenner MJ. Ultramicronized Palmitoylethanolamide and Luteolin Supplement Combined with Olfactory Training to Treat Post-COVID-19 Olfactory Impairment: A Multi-Center Double-Blinded Randomized Placebo- Controlled Clinical Trial. Curr Neuropharmacol 2022; 20:2001-2012. [PMID: 35450527 PMCID: PMC9886808 DOI: 10.2174/1570159x20666220420113513] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Olfactory training is the only evidence-based treatment for post-viral olfactory dysfunction. Smell disorders after SARS-CoV-2 infection have been attributed to neuroinflammatory events within the olfactory bulb and the central nervous system. Therefore, targeting neuroinflammation is one potential strategy for promoting recovery from post-COVID-19 chronic olfactory dysfunction. Palmitoylethanolamide and luteolin (PEA-LUT) are candidate antiinflammatory/ neuroprotective agents. OBJECTIVE To investigate recovery of olfactory function in patients treated with PEA-LUT oral supplements plus olfactory training versus olfactory training plus placebo. METHODS Multicenter double-blinded randomized placebo-controlled clinical trial was held. Eligible subjects had prior COVID-19 and persistent olfactory impairment >6 months after follow-up SARS-CoV-2 negative testing, without prior history of olfactory dysfunction or other sinonasal disorders. Participants were randomized to daily oral supplementation with ultramicronized PEA-LUT 770 mg plus olfactory training (intervention group) or olfactory training with placebo (control). Sniffin' Sticks assessments were used to test the patients at baseline and 90 days. RESULTS A total of 185 patients, including intervention (130) and control (55) were enrolled. The intervention group showed significantly greater improvement in olfactory threshold, discrimination, and identification scores compared to controls (p=0.0001). Overall, 92% of patients in the intervention group improved versus 42% of controls. Magnitude of recovery was significantly greater in the intervention group versus control (12.8 + 8.2 versus mean 3.2 + 3), with >10-fold higher prevalence of anosmia in control versus intervention groups at the 90-day endpoint. CONCLUSION Among individuals with olfactory dysfunction post-COVID-19, combining PEA-LUT with olfactory training resulted in greater recovery of smell than olfactory training alone.
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Affiliation(s)
- Arianna Di Stadio
- Address correspondence to this author at the University of Catania, Otolaryngology Department, Catania, Italy; E-mail:
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18
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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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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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20
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Abstract
Purpose of Review The diagnostic criteria of new daily persistent headache (NDPH) have been revised since 2013. The current review focused on the progress of NDPH research over the last few years. Recent Findings Various new triggers and different NDPH mimics have been reported. The association with both cephalic and extracephalic pathologies suggests that NDPH is rather a syndrome with more than one disease mechanism. Recent clinical studies confirmed that migrainous headache remained the most prominent phenotype of NDPH, echoing the change of the diagnostic criteria in 2013. Diagnostic workup, including imaging studies, was unremarkable, except serving to exclude secondary etiologies. Studies on treatment options have yet shown promising targets, and randomized clinical trials are still lacking. Summary Multiple mechanisms, both cranial and systemic, may be involved synergically in the generation of NDPH-like headaches. The search for effective treatment options should base on better understanding of disease mechanisms.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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21
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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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22
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Babaei A, Iravani K, Malekpour B, Golkhar B, Soltaniesmaeili A, Hosseinialhashemi M. Factors associated with anosmia recovery rate in COVID-19 patients. Laryngoscope Investig Otolaryngol 2021; 6:1248-1255. [PMID: 34909467 PMCID: PMC8661943 DOI: 10.1002/lio2.690] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives The present study aimed to assess the 4- and 8-week recovery rate of anosmia and determine the factors associated with recovery in COVID-19 patients. Method This retrospective study was conducted from December 2020 to March 2021. RT-PCR-proven COVID-19 adult patients (over 18 years of age) with a positive history of anosmia were included in this study. Anosmia was assessed based on the COVID-19 Anosmia Reporting Tool. The recovery rate of anosmia after 4 and 8 weeks were evaluated, and the relationship between the patients' recovery and their clinical and demographic data was assessed. Results A total of 235 patients were included. Their mean age (±SD) was 43.95 ± 15.27 years. Anosmia recovery was reported in 207(88.51%) and 219 (93.19%) participants till 4 and 8 weeks. The mean recovery time was 19.42 ± 8.81 days. The result of logistic regression showed that smoking (P = .031; OR = 10.813), ageusia (P = .002; OR = 5.340), headache (P = .006; OR = 0.243), and nasal discharge (P < .001; OR = 0.080) were significantly associated with 4 weeks anosmia recovery. The only risk factor which was associated with a lower rate of 8 weeks anosmia recovery was presence of nasal discharge (OR = 0.106, P = .002). Conclusion The only risk factor which was associated with a lower rate of 8 weeks anosmia recovery was presence of nasal discharge. Our result demonstrated that although smoking was associated with higher recovery rate till 4 weeks, it could not be considered as a protective factor after 8 weeks. More studies are recommended to investigate the relationship between anosmia and the associated factors by consideration of both short- and long-term recovery rates and assess the possible mechanisms that could justify this association. Levels of Evidence 3b.
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Affiliation(s)
- Amirhossein Babaei
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Kamyar Iravani
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
| | - Behzad Malekpour
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
| | - Behnaz Golkhar
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
| | - Amir Soltaniesmaeili
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
| | - Milad Hosseinialhashemi
- Otolaryngology Research Center, Department of OtolaryngologyShiraz University of Medical SciencesShirazIran
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23
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Membrilla JA, Caronna E, Trigo-López J, González-Martínez A, Layos-Romero A, Pozo-Rosich P, Guerrero-Peral Á, Gago-Veiga AB, Andrés-López A, Díaz de Terán J. Persistent headache after COVID-19: Pathophysioloy, clinic and treatment. NEUROLOGY PERSPECTIVES 2021; 1:S31-S36. [PMID: 38620971 PMCID: PMC8669731 DOI: 10.1016/j.neurop.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. The acute infection is characterised not only by respiratory symptoms, but also by multiple systemic manifestations, including neurological symptoms. Among these, headache is a frequent complaint. As the pandemic progresses and the population of patients recovering from COVID-19 grows, it is becoming apparent that the headache present in the acute stage of the infection may persist for an indeterminate period, becoming a major problem for the patient and potentially leading to disability. In this review we describe the pathophysiological and clinical aspects of persistent headache after COVID-19 based on the information currently available in the literature and the authors' clinical experience.
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Affiliation(s)
- J A Membrilla
- Unidad de Cefaleas Complejas y Dolor Neuropático, Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - E Caronna
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
- Grupo de Investigación en Cefalea y Dolor Neurológico, Instituto de Investigación Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Trigo-López
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A González-Martínez
- Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria La Princesa, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Layos-Romero
- Hospital General Universitario de Albacete, Albacete, Spain
| | - P Pozo-Rosich
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
- Grupo de Investigación en Cefalea y Dolor Neurológico, Instituto de Investigación Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Á Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A B Gago-Veiga
- Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria La Princesa, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - J Díaz de Terán
- Unidad de Cefaleas Complejas y Dolor Neuropático, Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Biosanitaria del Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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24
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The microvascular hypothesis underlying neurologic manifestations of long COVID-19 and possible therapeutic strategies. Cardiovasc Endocrinol Metab 2021; 10:193-203. [PMID: 34765889 PMCID: PMC8575441 DOI: 10.1097/xce.0000000000000253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023]
Abstract
With the ongoing distribution of the coronavirus disease (COVID) vaccines, the pandemic of our age is ending, leaving the world to deal with its well-documented aftereffects. Long COVID comprises a variety of symptoms, of which the neurological component prevails. The most permeating theory on the genesis of these symptoms builds upon the development of microvascular dysfunction similar to that seen in numerous vascular diseases such as diabetes. This can occur through the peripheral activation of angiotensin-converting enzyme 2 receptors, or through exacerbations of pro-inflammatory cytokines that can remain in circulation even after the infection diminishes. Several drugs have been identified to act on the neurovascular unit to promote repair, such as gliptins, and others. They also succeeded in improving neurologic outcome in diabetic patients. The repurposing of such drugs for treatment of long COVID-19 can possibly shorten the time to recovery of long COVID-19 syndrome.
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25
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Najafloo R, Majidi J, Asghari A, Aleemardani M, Kamrava SK, Simorgh S, Seifalian A, Bagher Z, Seifalian AM. Mechanism of Anosmia Caused by Symptoms of COVID-19 and Emerging Treatments. ACS Chem Neurosci 2021; 12:3795-3805. [PMID: 34609841 PMCID: PMC8507153 DOI: 10.1021/acschemneuro.1c00477] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
The occurrence of anosmia, the loss or change in sense of smell, is one of the most common symptoms of COVID-19 experienced by almost 53% of those affected. Several hypotheses explain the mechanism of anosmia in patients suffering from COVID-19. This study aims to review the related mechanisms and answer the questions regarding COVID-19-related anosmia as well as propose a new strategy for treatment of long-term anosmia as a result of COVID-19 infection. This paper covers all of the studies investigating olfactory disorders following COVID-19 infection and explains the possible reasons for the correlated anosmia, including olfactory cleft syndrome, local inflammation in the nasal epithelium, early apoptosis of olfactory cells, changes in olfactory cilia and odor transmission, damage to microglial cells, effect on olfactory bulbs, epithelial olfactory injury, and impairment of olfactory neurons and stem cells. The key questions that arise in this field have been discussed, such as why prevalent anosmia is varied among the age categories and among sexes and the correlation of anosmia with mild or severe COVID-19 infection. The angiotensin-converting enzyme 2 receptor is a significant player in the mechanism of anosmia in COVID-19 patients. Based on current studies, a novel approach to treat long-COVID-19 with ongoing anosmia has been proposed. The fields of smart drug delivery, tissue engineering, and cell therapy provide a hypothesized strategy that can minimize the side effects of current treatments and support efficient recovery of the olfactory system.
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Affiliation(s)
- Raziyeh Najafloo
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Jila Majidi
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Alimohamad Asghari
- Skull
Base Research Center, Hazrat Rasoul Akram Hospital, The Five Senses
Health Institute, Iran University of Medical
Sciences (IUMS), Tehran 1445613131, Iran
| | - Mina Aleemardani
- Biomaterials
and Tissue Engineering Group, Department of Materials Science and
Engineering, Kroto Research Institute, The
University of Sheffield, Sheffield S3 7HQ, United Kingdom
| | - Seyed Kamran Kamrava
- ENT
and Head and Neck Research Center and Department, Hazrat Rasoul Akram
Hospital, The Five Senses Health Institute, Iran University of Medical Sciences (IUMS), Tehran 1445613131, Iran
| | - Sara Simorgh
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Amelia Seifalian
- University
College London Medical School (UCL), London WC1E 6BT, United
Kingdom
- Watford
General Hospital, Watford WD18 0HB, United Kingdom
| | - Zohreh Bagher
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
- ENT
and Head and Neck Research Center and Department, Hazrat Rasoul Akram
Hospital, The Five Senses Health Institute, Iran University of Medical Sciences (IUMS), Tehran 1445613131, Iran
| | - Alexander M. Seifalian
- Nanotechnology
and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London NW1 0NH, United Kingdom
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26
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Caronna E, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Toward a better understanding of persistent headache after mild COVID-19: Three migraine-like yet distinct scenarios. Headache 2021; 61:1277-1280. [PMID: 34363619 PMCID: PMC8444902 DOI: 10.1111/head.14197] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022]
Abstract
One year after the outbreak of coronavirus disease 2019 (COVID‐19), referrals for persistent headache, often defined as “post‐COVID headache,” have become increasingly common in outpatient headache clinics. However, it is important to take into consideration that this term may include a spectrum of clinically different headache types. We describe three cases of migraine‐like headaches in individuals with a history of mild COVID‐19 infection to demonstrate some of the different phenotypes of persistent headaches seen. These cases highlight the importance of a careful evaluation when assessing the complexities of “post‐COVID headache” as well as the need to further investigate the different, underlying, pathophysiological mechanisms.
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Affiliation(s)
- Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 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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27
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Sullivan BN, Fischer T. Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:653694. [PMID: 34408638 PMCID: PMC8366271 DOI: 10.3389/fnagi.2021.653694] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
The outbreak of the novel and highly infectious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in hundreds of millions of infections and millions of deaths globally. Infected individuals that progress to coronavirus disease-19 (COVID-19) experience upper and lower respiratory complications that range in severity and may lead to wide-spread inflammation and generalized hypoxia or hypoxemia that impacts multiple organ systems, including the central and peripheral nervous systems. Since the SARS-CoV-2 outbreak, multiple reports continue to emerge that detail neurological symptoms, ranging from relatively mild (e.g., impaired taste and/or smell) to severe (e.g., stroke), suggesting SARS-CoV-2 may be neurotropic and/or contribute to nervous system injury through direct and/or indirect mechanisms. To gain insight into the types of neurological complications associated with SARS-CoV-2 infection and their possible relationship with age, sex, COVID-19 severity, and comorbidities, we performed a systematic review of case reports and series published in 2020 - April 4, 2021 of infected patients with neurological manifestations. Meta-analyses were conducted using individual patient data from reports where these data could be extracted. Here, we report neurological injury occurs across the lifespan in the context of infection, with and without known comorbidities, and with all disease severities, including asymptomatic patients. Older individuals, however, are more susceptible to developing life-threatening COVID-19 and cerebrovascular disease (CVD), such as stroke. A mild but inverse correlation with age was seen with CNS inflammatory diseases, such as encephalitis, as well as taste and/or smell disorders. When reported, increased age was also associated with comorbid cardiovascular risk factors, including hypertension, diabetes mellitus, and lipid disorders, but not with obesity. Obesity did correlate with development of critical COVID-19. Discussion into potential pathophysiological mechanisms by which neurological symptoms arise and long-term consequences of infection to the nervous system is also provided.
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Affiliation(s)
- Brianne N. Sullivan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Neuroscience Program, Tulane Brain Institute, School of Science and Engineering, Tulane University, New Orleans, LA, United States
| | - Tracy Fischer
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, United States
- Tulane Brain Institute, Tulane University School of Medicine, New Orleans, LA, United States
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28
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Waliszewska-Prosół M, Budrewicz S. The unusual course of a migraine attack during COVID-19 infection - Case studies of three patients. J Infect Public Health 2021; 14:903-905. [PMID: 34119843 PMCID: PMC8101002 DOI: 10.1016/j.jiph.2021.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
The effect of the coronavirus disease 2019 (COVID-19) on the nervous system remains undefined. Some studies have shown that headache is one of the most common symptoms and often the first neurological symptom in patients with confirmed infection. There are only a few reports concerning the effects of COVID-19 on the course of migraine. This article investigates three female patients with prolonged history of migraine, in which atypical phenomenology and course of migraine attacks were observed during COVID-19 infection.
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29
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Salamanna F, Veronesi F, Martini L, Landini MP, Fini M. Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data. Front Med (Lausanne) 2021; 8:653516. [PMID: 34017846 PMCID: PMC8129035 DOI: 10.3389/fmed.2021.653516] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023] Open
Abstract
Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a "post-COVID syndrome." The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.
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Affiliation(s)
- Francesca Salamanna
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Francesca Veronesi
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Lucia Martini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | | | - Milena Fini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
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30
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Wojtusiak J, Bagchi P, Durbha SSKRTN, Mobahi H, Mogharab Nia R, Roess A. COVID-19 Symptom Monitoring and Social Distancing in a University Population. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:114-131. [PMID: 33437913 PMCID: PMC7790352 DOI: 10.1007/s41666-020-00089-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
This paper reports on our efforts to collect daily COVID-19-related symptoms for a large public university population, as well as study relationship between reported symptoms and individual movements. We developed a set of tools to collect and integrate individual-level data. COVID-19-related symptoms are collected using a self-reporting tool initially implemented in Qualtrics survey system and consequently moved to .NET framework. Individual movement data are collected using off-the-shelf tracking apps available for iPhone and Android phones. Data integration and analysis are done in PostgreSQL, Python, and R. As of September 2020, we collected about 184,000 daily symptom responses for 20,000 individuals, as well as over 15,000 days of GPS movement data for 175 individuals. The analysis of the data indicates that headache is the most frequently reported symptom, present almost always when any other symptoms are reported as indicated by derived association rules. It is followed by cough, sore throat, and aches. The study participants traveled on average 223.61 km every week with a large standard deviation of 254.53 and visited on average 5.77 ± 4.75 locations each week for at least 10 min. However, there is no evidence that reported symptoms or prior COVID-19 contact affects movements (p > 0.3 in most models). The evidence suggests that although some individuals limit their movements during pandemics, the overall study population do not change their movements as suggested by guidelines.
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Affiliation(s)
- Janusz Wojtusiak
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Pramita Bagchi
- Department of Statistics, George Mason University, Fairfax, VA USA
| | | | - Hedyeh Mobahi
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Reyhaneh Mogharab Nia
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, VA USA
| | - Amira Roess
- Department of Global and Community Health, George Mason University, Fairfax, VA USA
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31
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Pohl H, Gantenbein AR. [COVID-19 and Headaches]. PRAXIS 2021; 110:201-206. [PMID: 33726510 DOI: 10.1024/1661-8157/a003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.
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Affiliation(s)
- Heiko Pohl
- Klinik für Neurologie, Universitätsspital Zürich
| | - Andreas R Gantenbein
- Klinik für Neurologie, Universitätsspital Zürich
- Neurologie & Neurorehabilitation, RehaClinic Bad Zurzach
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32
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Liu JWTW, de Luca RD, Mello Neto HO, Barcellos I. Post-COVID-19 Syndrome? New daily persistent headache in the aftermath of COVID-19. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:753-754. [PMID: 33331469 DOI: 10.1590/0004-282x20200187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Igor Barcellos
- Hospital Universitário Cajuru, Department of Neurology, Curitiba PR, Brazil
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33
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Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia 2020; 40:1443-1451. [PMID: 33146035 PMCID: PMC7645592 DOI: 10.1177/0333102420966770] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/05/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the frequency and characteristics of headache in patients with COVID-19 and whether there is an association between headache and anosmia and ageusia. METHODS This was a cross-sectional study. Consecutive patients admitted to hospital with COVID-19, confirmed by reverse transcription polymerase chain reaction (RT-PCR) technique, were assessed by neurologists. RESULTS Seventy-three patients were included in the study, 63% were male; the median age was 58 years (IQR: 47-66). Forty-seven patients (64.4%) reported headaches, which had most frequently begun on the first day of symptoms, were bilateral (94%), presenting severe intensity (53%) and a migraine phenotype (51%). Twelve patients (16.4%) presented with headache triggered by coughing. Eleven (15%) patients reported a continuous headache. Twenty-eight patients (38.4%) presented with anosmia and 29 (39.7%) with ageusia. Patients who reported hyposmia/anosmia and/or hypogeusia/ageusia experienced headache more frequently than those without these symptoms (OR: 5.39; 95% CI:1.66-17.45; logistic regression). Patients with anosmia and ageusia presented headache associated with phonophobia more often compared to those with headache without these complaints (Chi-square test; p < 0.05). Headache associated with COVID-19 presented a migraine phenotype more frequently in those experiencing previous migraine (p < 0.05). CONCLUSION Headaches associated with COVID-19 are frequent, are generally severe, diffuse, present a migraine phenotype and are associated with anosmia and ageusia.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, Brazil
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34
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Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology 2020; 63:141-145. [PMID: 33001220 PMCID: PMC7527786 DOI: 10.1007/s00234-020-02571-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/23/2020] [Indexed: 01/14/2023]
Abstract
The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged.
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Berger MM, Hackett PH, Bärtsch P. No Relevant Analogy Between COVID-19 and Acute Mountain Sickness. High Alt Med Biol 2020; 21:315-318. [PMID: 32970479 DOI: 10.1089/ham.2020.0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Berger, Marc Moritz, Peter H. Hackett, and Peter Bärtsch. No relevant analogy between COVID-19 and acute mountain sickness. High Alt Med Biol. 21:315-318, 2020.-Clinicians and scientists have suggested therapies for coronavirus disease-19 (COVID-19) that are known to be effective for other medical conditions. A recent publication suggests that pathophysiological mechanisms underlying acute mountain sickness (a syndrome of nonspecific neurological symptoms typically experienced by nonacclimatized individuals at altitudes >2500 m) may overlap with the mechanisms causing COVID-19. In this short review, we briefly evaluate this mistaken analogy and demonstrate that this concept is not supported by scientific evidence.
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Affiliation(s)
- Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter Bärtsch
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
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de Oliveira FAA, Palmeira DCC, Rocha-Filho PAS. Headache and pleocytosis in CSF associated with COVID-19: case report. Neurol Sci 2020; 41:3021-3022. [PMID: 32875474 PMCID: PMC7462730 DOI: 10.1007/s10072-020-04694-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/28/2020] [Indexed: 11/05/2022]
Abstract
In December 2019, a new coronavirus infection was identified in China. Although the clinical presentation of COVID-19 is predominantly respiratory, more than 35%% of patients have neurological symptoms. We report an elderly female with asthenia, dry cough, anosmia, ageusia, fever, nausea, and a severe and persistent headache. She had confirmed COVID-19 using the nasal swab RT-PCR technique. Her cranial tomography was normal. The CSF analysis demonstrated a cell count of 21 cells/mm3 (80% lymphocytes and 20% monocytes), 34 mg/dl protein, and 79 mg/dl glucose. She improved after 4 days. Our report draws attention to the meningeal involvement of SARS-Cov-2.
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Affiliation(s)
| | - Danylo César Correia Palmeira
- Real Hospital Português de Beneficência de Pernambuco, Recife, Brazil.,Universidade Federal de Pernambuco, Recife, Brazil
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