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Mitsikostas DD, Caronna E, De Tommaso M, Deligianni CI, Ekizoglu E, Bolay H, Göbel CH, Kristoffersen ES, Lampl C, Moro E, Pozo‐Rosich P, Sellner J, Terwindt G, Irimia‐Sieira P. Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review. Eur J Neurol 2024; 31:e16251. [PMID: 38415282 PMCID: PMC11235838 DOI: 10.1111/ene.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND PURPOSE The aim was to provide insights to the characteristics of headache in the context of COVID-19 on behalf of the Headache Scientific Panel and the Neuro-COVID-19 Task Force of the European Academy of Neurology (EAN) and the European Headache Federation (EHF). METHODS Following the Delphi method the Task Force identified six relevant questions and then conducted a systematic literature review to provide evidence-based answers and suggest specific diagnostic criteria. RESULTS No data for facial pain were identified in the literature search. (1) Headache incidence during acute COVID-19 varies considerably, with higher prevalence rates in prospective compared to retrospective studies (28.9%-74.6% vs. 6.5%-34.0%). (2) Acute COVID-19 headache is usually bilateral or holocranial and often moderate to severe with throbbing pain quality lasting 2-14 days after first signs of COVID-19; photo-phonophobia, nausea, anosmia and ageusia are common associated features; persistent headache shares similar clinical characteristics. (3) Acute COVID-19 headache is presumably caused by immune-mediated mechanisms that activate the trigeminovascular system. (4) Headache occurs in 13.3%-76.9% following SARS-CoV-2 vaccination and occurs more often amongst women with a pre-existing primary headache; the risk of developing headache is higher with the adenoviral-vector-type vaccines than with other preparations. (5) Headache related to SARS-CoV-2 vaccination is mostly bilateral, and throbbing, pressing, jolting or stabbing. (6) No studies have been conducted investigating the underlying mechanism of headache attributed to SARS-CoV-2 vaccines. CONCLUSION The results of this joint EAN/EHF initiative provide a framework for a better understanding of headache in the context of SARS-CoV-2 infection and vaccination.
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Affiliation(s)
| | - Edoardo Caronna
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina De Tommaso
- Neurophysiopathology Unit, DiBrain DepartmentAldo Moro UniversityBariItaly
| | | | - Esme Ekizoglu
- Department of Neurology, Faculty of MedicineIstanbul University, IstanbulIstanbulTurkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROMGazi University AnkaraAnkaraTurkey
| | - Carl H. Göbel
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Espen Saxhaug Kristoffersen
- Department of NeurologyAkershus University HospitalLørenskogNorway
- NorHEAD, Norwegian Centre for Headache ResearchAkershus University HospitalLørenskogNorway
- Department of General Practice, HELSAMUniversity of OsloOsloNorway
| | - Christian Lampl
- Department of Neurology and Stroke UnitKonventhospital Barmherzige Brüder LinzLinzAustria
- Headache Medical Center LinzLinzAustria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes UniversityGrenobleFrance
| | - Patricia Pozo‐Rosich
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Johann Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
| | - Gisela Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
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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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Bhattacharya M, Chatterjee S, Saxena S, Nandi SS, Lee SS, Chakraborty C. Current landscape of long COVID clinical trials. Int Immunopharmacol 2024; 132:111930. [PMID: 38537538 DOI: 10.1016/j.intimp.2024.111930] [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: 02/19/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 05/01/2024]
Abstract
Long COVID was reported as a multi-systemic condition after the infection of SARS-CoV-2, and more than 65 million people are suffering from this disease. It has been noted that around 10% of severe SARS-CoV-2 infected individuals are suffering from the enduring effects of long COVID. The symptoms of long COVID have also been noted in several mild or asymptomatic SARS-CoV-2 infected individuals. While limited reports on clinical trials investigating new therapeutics for long COVID exist, there is an abundance of scattered information available regarding these trials. This review explores the extensive literature search, and complete clinical trial database search to map the current status of long COVID clinical trials worldwide. The study listed about 110 long COVID clinical trials. In addition to conducting extensive long COVID clinical trials, we have comprehensively presented an overview of the condition, its symptoms, notable manifestations, associated clinical trials, the unique challenges it poses, and our recommendations for addressing long COVID.
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Affiliation(s)
- Manojit Bhattacharya
- Department of Zoology, Fakir Mohan University, Vyasa Vihar, Balasore 756020, Odisha, India
| | - Srijan Chatterjee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do 24252, Republic of Korea
| | - Sanskriti Saxena
- Division of Biology, Indian Institute of Science Education and Research-Tirupati, Panguru, Tirupati 517619, Andhra Pradesh, India
| | - Shyam Sundar Nandi
- ICMR-National Institute of Virology, (Mumbai unit), Indian Council of Medical Research, Haffkine Institute Compound, A. D. Marg, Parel, Mumbai 400012, India
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do 24252, Republic of Korea.
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal 700126, 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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Kabir MF, Yin KN, Jeffree MS, Ahmedy FB, Zainudin MF, Htwe O, Jahan S, Hossain MZ, Hossain KMA, Hossain T, Jahid IK, Chakrovorty SK. Clinical presentation of post-COVID pain and its impact on quality of life in long COVID patients: a cross-sectional household survey of SARS-CoV-2 cases in Bangladesh. BMC Infect Dis 2024; 24:375. [PMID: 38575878 PMCID: PMC10993502 DOI: 10.1186/s12879-024-09267-3] [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: 09/26/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Pain is one of the prevalent Long COVID Symptoms (LCS). Pain interferes with the quality of life (QoL) and induces disease burden. PURPOSE The study aimed to elicit the clinical presentation of pain and determine the relationships between QoL and pain in LCS. METHODS This household cross-sectional study of 12,925 SARS-CoV-2 cases between July and December 2021 was carried out in eight administrative divisions of Bangladesh. Stratified random sampling from the cases retrieved from the Ministry of Health was employed. Symptom screening was performed through COVID-19 Yorkshire Rehabilitation Scale, and long COVID was diagnosed according to World Health Organization (WHO) criteria. The analyses were conducted using IBM SPSS (Version 20.00). RESULTS The prevalence of pain in long COVID was between 01 and 3.1% in the studied population. The study also found five categories of pain symptoms as LCS in Bangladesh: muscle pain 3.1% (95% CI; 2.4-3.8), chest pain 2.4% (95% CI; 1.8-3.1), joint pain 2.8% (95% CI; 2.2-2.3), headache 3.1% (95% CI; 2.4-3.8), and abdominal pain 0.3% (95% CI; 0.01-0.5). People with LCS as pain, multiple LCS, and longer duration of LCS had significantly lower quality of life across all domains of the WHOQOL-BREF (P < 0.001) compared to asymptomatic cases. CONCLUSION Three out of ten people with long COVID experience painful symptoms, which can significantly reduce their quality of life. Comprehensive rehabilitation can improve the symptoms and reduce the burden of the disease.
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Affiliation(s)
- Md Feroz Kabir
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Khin Nyein Yin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Mohammad Saffree Jeffree
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Fatimah Binti Ahmedy
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | | | - Ohnmar Htwe
- Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sharmila Jahan
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Md Zahid Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - K M Amran Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Tofajjal Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Iqbal Kabir Jahid
- Department of Microbiology, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Sonjit Kumar Chakrovorty
- Department of Microbiology, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
- Dhaka College of Physiotherapy, under the Faculty of Medicine, University of Dhaka, Dhaka, Bangladesh
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Aiyegbusi OL. COVID-19 related headaches: epidemiology, pathophysiology, impacts, and management. Curr Opin Neurol 2023; 36:609-614. [PMID: 37865841 DOI: 10.1097/wco.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW This is an expert overview of the recent literature on the nature, epidemiology, pathophysiology, impact, and management of COVID-19 related headache, in the acute phase of infection and in post-COVID-19 syndrome. RECENT FINDINGS Headache is one of the commonest symptoms of COVID-19 during acute infection and it is often experienced by individuals who go on to develop long COVID. There is a higher prevalence of headache in individuals with long COVID who contracted the Delta variant than in those who were infected with the Wuhan or Alpha variants. Headaches related to COVID-19 infection are commoner and may be more intense in women.There are indications that presence of headache might indicate a more benign COVID-19 infection and a better chance of survival. However, the impact of COVID-19 related headache could be substantial leading to poor quality of life in individuals affected. Headache that changes in its nature in terms of frequency and severity should be investigated to exclude cerebrovascular complications. There are promising new therapies for its treatment, but further research is needed. SUMMARY The findings of this review can promote a better understanding of COVID-19 related headache and guide clinicians in the management of patients.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham
- NIHR Applied Research Collaboration (ARC) West Midlands
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
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Salsone M, Signorelli C, Oldani A, Alberti VF, Castronovo V, Mazzitelli S, Minerva M, Ferini-Strambi L. NEURO-COVAX: An Italian Population-Based Study of Neurological Complications after COVID-19 Vaccinations. Vaccines (Basel) 2023; 11:1621. [PMID: 37897023 PMCID: PMC10610846 DOI: 10.3390/vaccines11101621] [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: 09/01/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE In this Italian population-based study, we aimed to evaluate the neurological complications after the first and/or second dose of COVID-19 vaccines and factors potentially associated with these adverse effects. METHODS Our study included adults aged 18 years and older who received two vaccine doses in the vaccination hub of Novegro (Milan, Lombardy) between 7 and 16 July 2021. The NEURO-COVAX questionnaire was able to capture the neurological events, onset and duration. That data that were digitized centrally by the Lombardy region were used to match the demographic/clinical characteristics and identify a vulnerability profile. Associations between vaccine lines and the development of complications were assessed. Digital healthcare system matching was also performed to evaluate severe neurological complications (Guillain-Barrè syndrome, Bell's palsy, transverse myelitis, encephalitis) and the incidence of hospital admissions and/or the mortality rate after two doses of the vaccines. RESULTS The NEURO-COVAX-cohort included 19.108 vaccinated people: 15.368 with BNT162b2, 2077 with mRNA-1273, 1651 with ChAdOx1nCov-19, and 12 with Ad26.COV2.S who were subsequently excluded. Approximately 31.2% of our sample developed post-vaccination neurological complications, particularly with ChAdOx1nCov-19. A vulnerable clinical profile emerged, where over 40% of the symptomatic people showed comorbidities in their clinical histories. Defining the neurological risk profile, we found an increased risk for ChAdOx1nCov-19 of tremors (vs. BNT162b2, OR: 5.12, 95% CI: 3.51-7.48); insomnia (vs. mRNA-1273, OR: 1.87, 95% CI: 1.02-3.39); muscle spasms (vs. BNT162b2, OR: 1.62, 95% CI: 1.08-2.46); and headaches (vs. BNT162b2, OR: 1.49, 95% CI: 0.96-1.57). For mRNA-1273, there were increased risks of parethesia (vs. ChAdOx1nCov-19, OR: 2.37, 95% CI: 1.48-3.79); vertigo (vs. ChAdOx1nCov-19, OR: 1.68, 95% CI: 1.20-2.35); diplopia (vs. ChAdOx1nCov-19, OR: 1.55, 95% CI: 0.67-3.57); and sleepiness (vs. ChAdOx1nCov-19, OR: 1.28, 95% CI: 0.98-1.67). In the period that ranged from March to August 2021, no one was hospitalized and/or died of severe complications related to COVID-19 vaccinations. DISCUSSION This study estimates the prevalence and risk for neurological complications potentially associated with COVID-19 vaccines, thus improving the vaccination guidelines and loading in future personalized preventive medicine.
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Affiliation(s)
- Maria Salsone
- Institute of Molecular Bioimaging and Physiology, National Research Council, 20125 Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandro Oldani
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, 20127 Milan, Italy
| | | | - Vincenza Castronovo
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, 20127 Milan, Italy
| | | | - Massimo Minerva
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, 20127 Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Wesselingh R. Prevalence, pathogenesis and spectrum of neurological symptoms in COVID-19 and post-COVID-19 syndrome: a narrative review. Med J Aust 2023; 219:230-236. [PMID: 37660309 DOI: 10.5694/mja2.52063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 09/05/2023]
Abstract
Neurological symptoms are not uncommon during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reflect a broad spectrum of neurological disorders of which clinicians should be aware. The underlying pathogenesis of neurological disease in coronavirus disease 2019 (COVID-19) may be due to four mechanisms of nervous system dysfunction and injury: i) direct viral neurological invasion; ii) immune dysregulation; iii) endothelial dysfunction and coagulopathy; and iv) severe systemic COVID-19 disease. Neurological manifestations of acute COVID-19 include headache, peripheral neuropathies, seizures, encephalitis, Guillain-Barré syndrome, and cerebrovascular disease. Commonly reported long term neurological sequelae of COVID-19 are cognitive dysfunction and dysautonomia, which despite being associated with severe acute disease are also seen in people with mild disease. Assessment of cognitive dysfunction after COVID-19 is confounded by a high prevalence of comorbid fatigue, anxiety, and mood disorders. However, other markers of neuroaxonal breakdown suggest no significant neuronal injury apart from during severe acute COVID-19. The long term impact of COVID-19 on neurological diseases remains uncertain and requires ongoing vigilance.
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Affiliation(s)
- Robb Wesselingh
- Monash University, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
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Jameie M, Togha M, Azizmohammad Looha M, Jafari E, Yazdan Panah M, Hemmati N, Nasergivehchi S. Characteristics of headaches attributed to SARS-CoV-2 vaccination and factors associated with its frequency and prolongation: a cross-sectional cohort study. Front Neurol 2023; 14:1214501. [PMID: 37602254 PMCID: PMC10433229 DOI: 10.3389/fneur.2023.1214501] [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: 04/29/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Background Headache is the most frequent neurological adverse event following SARS-CoV-2 vaccines. We investigated the frequency, characteristics, and factors associated with post-vaccination headaches, including their occurrence and prolongation (≥ 48 h). Methods In this observational cross-sectional cohort study, retrospective data collected between April 2021-March 2022 were analyzed. Univariate and multivariate logistic regressions were used to evaluate the effect of clinicodemographic factors on the odds of post-vaccination headache occurrence and prolongation. Results Of 2,500 people who were randomly sent the questionnaire, 1822 (mean age: 34.49 ± 11.09, female: 71.5%) were included. Headache prevalence following the first (V1), second (V2), and third (V3) dose was 36.5, 23.3, and 21.7%, respectively (p < 0.001). Post-vaccination headaches were mainly tension-type (46.5%), followed by migraine-like (36.1%). Headaches were mainly bilateral (69.7%), pressing (54.3%), moderate (51.0%), and analgesic-responsive (63.0%). They mainly initiated 10 h [4.0, 24.0] after vaccination and lasted 24 h [4.0, 48.0]. After adjusting for age and sex, primary headaches (V1: aOR: 1.32 [95%CI: 1.08, 1.62], V2: 1.64 [1.15, 2.35]), post-COVID-19 headaches (V2: 2.02 [1.26, 3.31], V3: 2.83 [1.17, 7.47]), headaches following the previous dose (V1 for V2: 30.52 [19.29, 50.15], V1 for V3: 3.78 [1.80, 7.96], V2 for V3: 12.41 [4.73, 35.88]), vector vaccines (V1: 3.88 [3.07, 4.92], V2: 2.44 [1.70, 3.52], V3: 4.34 [1.78, 12.29]), and post-vaccination fever (V1: 4.72 [3.79, 5.90], V2: 6.85 [4.68, 10.10], V3: 9.74 [4.56, 22.10]) increased the odds of post-vaccination headaches. Furthermore, while primary headaches (V1: 0.63 [0.44, 0.90]) and post-COVID-19 headaches (V1: 0.01 [0.00, 0.05]) reduced the odds of prolonged post-vaccination headaches, psychiatric disorders (V1: 2.58 [1.05, 6.45]), headaches lasting ≥48 h following the previous dose (V1 for V2: 3.10 [1.08, 10.31]), and migraine-like headaches at the same dose (V3: 5.39 [1.15, 32.47]) increased this odds. Conclusion Patients with primary headaches, post-COVID-19 headaches, or headaches following the previous dose, as well as vector-vaccine receivers and those with post-vaccination fever, were at increased risk of post-SARS-CoV-2-vaccination headaches. Primary headaches and post-COVID-19 headaches reduced the odds of prolonged post-vaccination headaches. However, longer-lasting headaches following the previous dose, migraine-like headaches at the same dose, and psychiatric disorders increased this odd.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Jafari
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nima Hemmati
- Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Nasergivehchi
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Foo SS, Chen W, Jung KL, Azamor T, Choi UY, Zhang P, Comhair SA, Erzurum SC, Jehi L, Jung JU. Immunometabolic rewiring in long COVID patients with chronic headache. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.06.531302. [PMID: 36945569 PMCID: PMC10028820 DOI: 10.1101/2023.03.06.531302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Almost 20% of patients with COVID-19 experience long-term effects, known as post-COVID condition or long COVID. Among many lingering neurologic symptoms, chronic headache is the most common. Despite this health concern, the etiology of long COVID headache is still not well characterized. Here, we present a longitudinal multi-omics analysis of blood leukocyte transcriptomics, plasma proteomics and metabolomics of long COVID patients with chronic headache. Long COVID patients experienced a state of hyper-inflammation prior to chronic headache onset and maintained persistent inflammatory activation throughout the progression of chronic headache. Metabolomic analysis also revealed augmented arginine and lipid metabolisms, skewing towards a nitric oxide-based pro-inflammation. Furthermore, metabolisms of neurotransmitters including serotonin, dopamine, glutamate, and GABA were markedly dysregulated during the progression of long COVID headache. Overall, these findings illustrate the immuno-metabolomics landscape of long COVID patients with chronic headache, which may provide insights to potential therapeutic interventions.
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Fernández-de-Las-Peñas C, Cuadrado ML, Gómez-Mayordomo V, García-Azorín D, Arendt-Nielsen L. Headache as a COVID-19 onset symptom or Post-COVID symptom according to the SARS-CoV-2 Variant. Expert Rev Neurother 2023; 23:179-186. [PMID: 36857191 DOI: 10.1080/14737175.2023.2185138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION COVID19 associated headaches are highly common and there is currently an unmet need to better understand their association with SARSCoV2 variants. Headaches are a prevalent symptom in the acute phase of COVID19 and are associated with a better prognosis and better immune response. They are also a relevant post-COVID symptom. AREAS COVERED This article analyses the differences in the prevalence of headache as an onset symptom and in post-COVID headache among the different SARS-CoV-2 variants: the historical strain, Alpha, Delta and Omicron. The different pathophysiological mechanisms by which SARS-CoV-2 infection may cause headache are also discussed. EXPERT OPINION The presence of headache at the acute phase is a risk factor for post-COVID headache, whereas a history of primary headache does not appear to be associated with post-COVID headache. The prevalence of headache as an onset symptom appears to be variable for the different SARS-CoV-2 variants, but current data are inconclusive. However, the current evidence also suggests that headache represents a prevalent symptom in the acute and post-infection COVID-19 phase, regardless of SARS-CoV-2 variant.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Victor Gómez-Mayordomo
- Department of Neurology, Institute of Neurosciences, Vithas Madrid La Milagrosa University Hospital. Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, AMech-Sense, alborg University Hospital, Aalborg, Denmark
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12
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Caronna E, van den Hoek TC, Bolay H, Garcia-Azorin D, Gago-Veiga AB, Valeriani M, Takizawa T, Messlinger K, Shapiro RE, Goadsby PJ, Ashina M, Tassorelli C, Diener HC, Terwindt GM, Pozo-Rosich P. Headache attributed to SARS-CoV-2 infection, vaccination and the impact on primary headache disorders of the COVID-19 pandemic: A comprehensive review. Cephalalgia 2023; 43:3331024221131337. [PMID: 36606562 DOI: 10.1177/03331024221131337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective is to summarize the knowledge on the epidemiology, pathophysiology and management of secondary headache attributed to SARS-CoV-2 infection and vaccination; as well as to delineate their impact on primary headache disorders. METHODS This is a narrative review of the literature regarding primary and secondary headache disorders in the setting of COVID-19 pandemic. We conducted a literature search in 2022 on PubMed, with the keywords "COVID 19" or "vaccine" and "headache" to assess the appropriateness of all published articles for their inclusion in the review. RESULTS Headache is a common and sometimes difficult-to-treat symptom of both the acute and post-acute phase of SARS-CoV-2 infection. Different pathophysiological mechanisms may be involved, with the trigeminovascular system as a plausible target. Specific evidence-based effective therapeutic options are lacking at present. Headache attributed to SARS-CoV-2 vaccinations is also common, its pathophysiology being unclear. People with primary headache disorders experience headache in the acute phase of COVID-19 and after vaccination more commonly than the general population. Pandemic measures, forcing lifestyle changes, seemed to have had a positive impact on migraine, and changes in headache care (telemedicine) have been effectively introduced. CONCLUSIONS The ongoing COVID-19 pandemic is a global challenge, having an impact on the development of secondary headaches, both in people with or without primary headaches. This has created opportunities to better understand and treat headache and to potentiate strategies to manage patients and ensure care.
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Affiliation(s)
- Edoardo Caronna
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROM, Gazi University Hospital, Ankara, Turkey
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, Erlangen-Nuernberg, Germany
| | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, USA
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK.,Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Hans-Christoph Diener
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE) Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patricia Pozo-Rosich
- Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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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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14
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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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15
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Magdy R, Khedr D, Yacoub O, Attia A, Abdelrahman MA, Mekkawy D. Epidemiological aspects of headache after different types of
COVID
‐19 vaccines: An online survey. Headache 2022; 62:1046-1052. [PMID: 36005277 PMCID: PMC9538602 DOI: 10.1111/head.14374] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Rehab Magdy
- Department of Neurology, Kasr Al‐Ainy Faculty of Medicine Cairo University Cairo Egypt
| | - Diana Khedr
- Department of Neurology, Kasr Al‐Ainy Faculty of Medicine Cairo University Cairo Egypt
| | - Osama Yacoub
- Department of Neurology, Kasr Al‐Ainy Faculty of Medicine Cairo University Cairo Egypt
| | - Abeer Attia
- Department of Public Health and Community Medicine, Faculty of Medicine Cairo University Cairo Egypt
| | | | - Doaa Mekkawy
- Department of Neurology, Kasr Al‐Ainy Faculty of Medicine Cairo University Cairo Egypt
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16
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Association of Acute Headache of COVID-19 and Anxiety/Depression Symptoms in Adults Undergoing Post-COVID-19 Rehabilitation. J Clin Med 2022; 11:jcm11175002. [PMID: 36078932 PMCID: PMC9457235 DOI: 10.3390/jcm11175002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
As a common non-respiratory symptom of COVID-19, headache should not be overlooked, and its characteristics should be recorded with scrutiny. Identifying risk factors associated with post-COVID headache will ensure immediate action and counseling for this population of patients. Therefore, the study aimed to investigate the relationship between headache and psychological state (stress level, depression, and anxiety symptoms) in adults undergoing post-COVID-19 rehabilitation. In addition, we used mediation analysis to evaluate the mediation effect of psychological variables in the relationship between headache and quality of life. This cross-sectional study included 147 patients undergoing post-COVID-19 rehabilitation at the Public Hospital in Poland (64 males, 83 females, with mean age of 56.97 years). Psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-10), and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). Additionally, all participants completed a questionnaire related to COVID-19 symptoms and their severity, the place of COVID-19 treatment, and the need for oxygen therapy during hospitalization. Of all participants, 65% experienced headache during COVID-19. Of the participants with headache, there were significantly more females in this group (69% vs. 31%), and they were significantly younger (mean age 55.47 vs. 59.78 years). Participants with headache had a 27% higher HADS-D score, a 21% higher HADS-A score, and a 13% higher PSS-10 score. Moreover, gender and headache were found to be important predictor variables for total HADS and HADS-D, accounting for 11% and 7%, respectively. Mediation analysis has shown that the tested psychological variables mediated 39–68% of the total effect of headache influence on WHOQOL domains. In conclusion, our study demonstrated several relationships between headache that occurred during COVID-19 and symptoms of depression, anxiety, and perceived stress level during post-COVID rehabilitation also in the context of quality of life. Our results show that patients who experienced headaches during COVID-19 are at high risk of developing anxiety-depressive symptoms later. Female gender is associated with a higher prevalence of headache during COVID-19.
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17
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Khoja O, Silva Passadouro B, Mulvey M, Delis I, Astill S, Tan AL, Sivan M. Clinical Characteristics and Mechanisms of Musculoskeletal Pain in Long COVID. J Pain Res 2022; 15:1729-1748. [PMID: 35747600 PMCID: PMC9212788 DOI: 10.2147/jpr.s365026] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Musculoskeletal (MSK) pain is being increasingly reported by patients as one of the most common persistent symptoms in post-COVID-19 syndrome or Long COVID. However, there is a lack of understanding of its prevalence, characteristics, and underlying pathophysiological mechanisms. The objective of this review is to identify and describe the features and characteristics of MSK pain in Long COVID patients. Methods The narrative review involved a literature search of the following online databases: MEDLINE (OVID), EMBASE (OVID), CINAHL, PsyclNFO, and Web of Science (December 2019 to February 2022). We included observational studies that investigated the prevalence, characteristics, risk factors and mechanisms of MSK pain in Long COVID. After screening and reviewing the initial literature search results, a total of 35 studies were included in this review. Results The overall reported prevalence of MSK pain in Long COVID ranged widely from 0.3% to 65.2%. The pain has been reported to be localized to a particular region or generalized and widespread. No consistent pattern of progression of MSK pain symptoms over time was identified. Female gender and higher BMI could be potential risk factors for Long COVID MSK pain, but no clear association has been found with age and ethnicity. Different pathophysiological mechanisms have been hypothesized to contribute to MSK pain in Long COVID including increased production of proinflammatory cytokines, immune cell hyperactivation, direct viral entry of neurological and MSK system cells, and psychological factors. Conclusion MSK pain is one of the most common symptoms in Long COVID. Most of the current literature on Long COVID focuses on reporting the prevalence of persistent MSK pain. Studies describing the pain characteristics are scarce. The precise mechanism of MSK pain in Long COVID is yet to be investigated. Future research must explore the characteristics, risk factors, natural progression, and underlying mechanisms of MSK pain in Long COVID.
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Affiliation(s)
- Omar Khoja
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Matthew Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ioannis Delis
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Sarah Astill
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
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18
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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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19
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Sampaio Rocha-Filho PA, Albuquerque PM, Carvalho LCLS, Dandara Pereira Gama M, Magalhães JE. Headache, anosmia, ageusia and other neurological symptoms in COVID-19: a cross-sectional study. J Headache Pain 2022; 23:2. [PMID: 34979899 PMCID: PMC8721484 DOI: 10.1186/s10194-021-01367-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background Neurological symptoms are frequent among patients with COVID-19. Little is known regarding the repercussions of neurological symptoms for patients and how these symptoms are related to one another. Objectives To determine whether there is an association between the neurological symptoms in patients with COVID-19, and to characterize the headache. Method This was a cross-sectional study. All hospital inpatients and health workers at the Hospital Universitario Oswaldo Cruz with a PCR-confirmed COVID-19 infection between March and June 2020 were considered for the study and were interviewed by telephone at least 2-months after the acute phase of the disease. These patients were identified by the hospital epidemiological surveillance department. A semi-structured questionnaire was used containing sociodemographic and clinical data and the ID-Migraine. Results A total of 288 patients was interviewed; 53.1% were male; with a median age of 49.9 (41.5–60.5) years; 91.7% presented some neurological symptom; 22.2% reported some neurological symptom as the symptom that troubled them most during COVID-19. Neurological symptoms were: ageusia (69.8%), headache (69.1%), anosmia (67%), myalgia (44.4%), drowsiness (37.2%), agitation (20.8%); mental confusion (14.9%), syncope (4.9%) and epileptic seizures (2.8%). Females, those who presented with fever, sore throat, anosmia/ageusia and myalgia also presented significantly more with headache (logistic regression). The most frequent headache phenotype was a non-migraine phenotype, was of severe intensity and differed from previous headaches. This persisted for more than 30 days in 18% and for more than 90 days in 10% of patients. Thirteen percent of those with anosmia and 11% with ageusia continued with these complaints after more than 90 days of the acute phase of the disease. Aged over 50 years, agitation and epileptic seizures were significantly associated with mental confusion (logistic regression). Conclusion Headache is frequent in COVID-19, is associated with other symptoms such as fever, sore throat, anosmia, ageusia, and myalgia, and may persist beyond the acute phase of the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01367-8.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Av. da Engenharia, 531-611, Recife, PE, 50730-120, Brazil. .,Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil.
| | - Pedro Mota Albuquerque
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Av. da Engenharia, 531-611, Recife, PE, 50730-120, Brazil
| | | | - Mylana Dandara Pereira Gama
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Tv. Jackson Pollock - Santo Amaro, Recife, PE, 52171-011, Brazil
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20
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Togha M. Headaches attributed to COVID-19 infection. HEADACHE AND MIGRAINE IN PRACTICE 2022. [PMCID: PMC9395209 DOI: 10.1016/b978-0-323-99729-4.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Headache is a common neurologic manifestation of COVID-19 that usually has benign features and has been considered as a good prognostic factor. However, occasionally such symptoms could be due to a serious cause such as cerebral venous sinus thrombosis or meningitis/encephalitis. The activation of the trigeminovascular system has been proposed as an underlying mechanism of headaches that are associated with disease. The ICHD3 criteria can be used to classify headaches as acute related to systemic viral infection, viral meningitis, encephalitis, or other noninflammatory intracranial diseases, as secondary cough headaches, headaches attributed to hypoxia and/or hypercapnia, headaches due to cranial or cervical vascular disorders, and headaches attributed to increased cerebrospinal fluid pressure. Apart from headaches caused by infection with COVID-19, an increasing number of patients, with or without a previous history of headache, have experienced them because of lifestyle changes during the COVID-19 pandemic.
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21
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Göbel CH, Heinze A, Karstedt S, Morscheck M, Tashiro L, Cirkel A, Hamid Q, Halwani R, Temsah MH, Ziemann M, Görg S, Münte T, Göbel H. Headache Attributed to Vaccination Against COVID-19 (Coronavirus SARS-CoV-2) with the ChAdOx1 nCoV-19 (AZD1222) Vaccine: A Multicenter Observational Cohort Study. Pain Ther 2021; 10:1309-1330. [PMID: 34313952 PMCID: PMC8314854 DOI: 10.1007/s40122-021-00296-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The most frequently reported neurological adverse event of ChAdOx1 nCoV-19 (AZD1222) vaccine is headache in 57.5%. Several cases of cerebral venous thrombosis (CVT) have developed after vaccination. Headache is the leading symptom of CVT. For the differential diagnosis of headaches attributed to this vaccine and headaches attributed to CVT, it is of central clinical importance whether and, if so, how the phenotypes and course of these headaches can be differentiated. The study aims to examine in detail the phenotype of headache attributed to this vaccine. METHODS Data on the clinical features and corresponding variables were recorded using a standardized online questionnaire in this multicenter observational cohort study. The primary outcomes of this study are the clinical features of headaches after vaccination. FINDINGS A total of 2464 participants reported headaches after vaccination with the ChAdOx1 nCoV-19 (AZD1222) vaccine. On average, headaches occurred 14.5 ± 21.6 h after vaccination and lasted 16.3 ± 30.4 h. A bilateral location was described by 75.8% of participants. This is most often found on the forehead (40.0%) and temples (31.4%); 50.4% reported a pressing and 37.7% a dull pain character. Headache intensity was most often severe (38.7%), moderate (35.2%), or very severe (15.5%). Accompanying symptoms were most commonly fatigue (44.8%), chills (36.1%), exhaustion (34.9%), and fever (30.4%). CONCLUSION Headaches attributed to COVID-19 vaccination with the ChAdOx1 nCoV-19 (AZD1222) vaccine demonstrate an extensive and characteristic complex of symptoms. The findings have several important clinical implications for the differentiation of post-vaccinal headache and other primary as well as secondary headaches.
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Affiliation(s)
- Carl H. Göbel
- grid.412468.d0000 0004 0646 2097Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany ,Kiel Migraine and Headache Centre, Kiel, Germany
| | - Axel Heinze
- Kiel Migraine and Headache Centre, Kiel, Germany
| | | | | | | | - Anna Cirkel
- grid.412468.d0000 0004 0646 2097Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany ,Kiel Migraine and Headache Centre, Kiel, Germany
| | - Qutyaba Hamid
- grid.412789.10000 0004 4686 5317Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates ,grid.412789.10000 0004 4686 5317Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- grid.412789.10000 0004 4686 5317Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates ,grid.412789.10000 0004 4686 5317Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamad-Hani Temsah
- grid.56302.320000 0004 1773 5396College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Malte Ziemann
- grid.412468.d0000 0004 0646 2097Institute of Transfusion Medicine, University Hospital Schleswig-Holstein, Campus, Lübeck, Germany
| | - Siegfried Görg
- grid.412468.d0000 0004 0646 2097Institute of Transfusion Medicine, University Hospital Schleswig-Holstein, Campus, Lübeck, Germany
| | - Thomas Münte
- grid.412468.d0000 0004 0646 2097Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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22
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Abstract
Purpose of Review Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. Recent Findings The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Summary Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.
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23
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Potential for Stem Cell-Based Therapy in the Road of Treatment for Neurological Disorders Secondary to COVID-19. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021; 8:355-369. [PMID: 34746370 PMCID: PMC8555723 DOI: 10.1007/s40883-021-00234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Abstract
The severe acute respiratory syndrome coronavirus 2 has led to the worldwide pandemic named coronavirus disease 2019 (COVID-19). It has caused a significant increase in the number of cases and mortalities since its first diagnosis in December 2019. Although COVID-19 primarily affects the respiratory system, neurological involvement of the central and peripheral nervous system has been also reported. Herein, the higher risk of neurodegenerative diseases in COVID-19 patients in future is also imaginable. Neurological complications of COVID-19 infection are more commonly seen in severely ill individuals; but, earlier diagnosis and treatment can lead to better long-lasting results. In this respect, stem cell biotechnologies with considerable self-renewal and differentiation capacities have experienced great progress in the field of neurological disorders whether in finding out their underlying processes or proving them promising therapeutic approaches. Herein, many neurological disorders have been found to benefit from stem cell medicine strategies. Accordingly, in the present review, the authors are trying to discuss stem cell-based biotechnologies as promising therapeutic options for neurological disorders secondary to COVID-19 infection through reviewing neurological manifestations of COVID-19 and current stem cell-based biotechnologies for neurological disorders. Lay Summary Due to the substantial burden of neurological disorders in the health, economic, and social system of society, the emergence of neurological manifestations following COVID-19 (as a life-threatening pandemic) creates the need to use efficient and modern methods of treatment. Since stem cell-based methods have been efficient for a large number of neurological diseases, it seems that the use of mentioned methods is also effective in the process of improving neurological disorders caused by COVID-19. Hereupon, the current review aims to address stem cell-based approaches as treatments showing promise to neurological disorders related to COVID-19.
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Salomão VR, Baccarin AJR, Okido TY. Most prevalent symptoms associated with headache in COVID-19 patients in the acute phase: a systematic review. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
IntroductionConsidering the frequency of headache among the neurological symptoms of COVID-19, there is a need to understand other manifestations associated with this complaint.ObjectiveTo review the literature regarding the most prevalent symptoms associated with headache in patients diagnosed with COVID-19.MethodA systematic literature review was carried out on studies that evaluated published articles about clinical characteristics and headache associated symptoms in patients diagnosed with COVID-19.ResultsAmong the 1,190 patients in the analyzed studies, the following signs and symptoms were associated with headache: fever, hyposmia, anosmia, ageusia, phonophobia, dehydration, prostration and symptoms of the gastrointestinal tract.ConclusionHeadache was the main neurological symptom of COVID-19, among the main associated symptoms are fever, hyposmia or anosmia, ageusia and phonophobia.
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Oguz-Akarsu E, Gullu G, Kilic E, Dinç Y, Ursavas A, Yilmaz E, Zarifoglu M, Karli N. Insight into pain syndromes in acute phase of mild-to-moderate COVID-19: Frequency, clinical characteristics, and associated factors. Eur J Pain 2021; 26:492-504. [PMID: 34622527 PMCID: PMC8653127 DOI: 10.1002/ejp.1876] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/18/2021] [Accepted: 10/03/2021] [Indexed: 01/08/2023]
Abstract
Background Pain has been frequently described as a clinical feature of COVID‐19, and the main pain syndromes that have been associated with the acute phase of this disease so far are headache, myalgia, arthralgia, and neuropathic pain. Understanding the characteristics of pain symptoms is crucial for a better clinical approach. Methods Patients who were diagnosed as having COVID‐19 using reverse transcription‐polymerase chain reaction were included in the study. Patients were asked to complete a 51‐item questionnaire via a phone interview, which included questions on demographics, acute COVID‐19 symptoms, the presence of pain symptoms, and their characteristics in the acute phase of COVID‐19. Results A total of 222 out of 266 patients with COVID‐19 participated in the study, yielding a response rate of 83.5%. A total of 159 patients reported at least one kind of pain syndrome with a prevalence of 71.6%. Myalgia was reported in 110 (49.6%) patients, headache in 109 (49.1%), neuropathic pain symptoms in 55 (24.8%), and polyarthralgia in 30 (13.5%) patients. A total of 66 patients reported only one type of pain, 46 reported two types, 42 reported three types, and five patients reported all four types of pain. Logistic regression analysis showed that there were significant associations between these pain syndromes and a strong association was found between neuropathic pain and headache. Conclusion Pain is a frequently observed symptom of mild‐to‐moderate COVID‐19. There are significant relationships between pain syndromes in COVID‐19, which may be due to a sequence of common etiologic factors. Significance This study described the main pain syndromes associated acute phase of mild‐to‐moderate COVID‐19 and its associated features. Headaches and pain of neuropathic characteristics were prevalent in this sample.
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Affiliation(s)
- Emel Oguz-Akarsu
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Gizem Gullu
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Erhan Kilic
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Yasemin Dinç
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Ahmet Ursavas
- Department of Chest Diseases, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Emel Yilmaz
- Department of Infectious Disease, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Mehmet Zarifoglu
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Necdet Karli
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
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Hussein M, Fathy W, Eid RA, Abdel-Hamid HM, Yehia A, Sheemy MS, Ragaie C, Dahshan A, Rizk HI, Laz N, Magdy R. Relative Frequency and Risk Factors of COVID-19 Related Headache in a Sample of Egyptian Population: A Hospital-Based Study. PAIN MEDICINE 2021; 22:2092-2099. [PMID: 33544857 PMCID: PMC7928553 DOI: 10.1093/pm/pnab020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives Headache is considered one of the most frequent neurological manifestations of COVID-19. This work aimed to identify the relative frequency of COVID-19 related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. Design Cross-sectional study Setting Recovered COVID-19 patients Subjects 782 patients with a confirmed diagnosis of COVID-19 infection. Methods Clinical, laboratory and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. Results The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% CI (0.516–0.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. Discussion Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.
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Affiliation(s)
- Mona Hussein
- Department of Neurology, Beni-Suef University, Beni-Suef, Egypt
| | - Wael Fathy
- Department of Anaesthesia, Surgical ICU and Pain management, Beni-Suef University, Beni-Suef, Egypt
| | - Ragaey A Eid
- Department of Tropical medicine, Beni-suef University, Beni-Suef, Egypt
| | | | - Ahmed Yehia
- Department of Internal medicine, Beni-suef University, Beni-Suef, Egypt
| | - Mostafa S Sheemy
- Department of Medical Microbiology and Immunology, Beni-suef University, Beni-Suef, Egypt
| | | | - Ahmed Dahshan
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Hoda I Rizk
- Department of Public Health and Community Medicine, Cairo University, Cairo, Egypt
| | - Nabila Laz
- Department of Chest diseases, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
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Shams Vahdati S, Ala A, Rahmanpour D, Sadeghi-Hokmabadi E, Tahmasbi F. Neurological manifestations of COVID-19 infection: an umbrella review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:113. [PMID: 34483649 PMCID: PMC8401342 DOI: 10.1186/s41983-021-00366-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neurological involvements of COVID-19 are one of the most reported manifestations of this infection. This study aims to systematically review the previous systematic reviews which addressed the neurological manifestations of the COVID-19 infection. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science databases and Google Scholar from December 2019 to December 2020. Articles were critically screened by two independent reviewers and if met the inclusion criteria, entered the study. Assessment of methodological quality was conducted by Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. Statistical analysis was not applicable. From a total of 1302 studies, 308 studies were removed due to their irrelevant title and abstract. After screening the full texts, a total of 66 found to be eligible. Twenty-one studies reported general manifestations of the COVID-19, 13 studies reported cerebrovascular events, 19 olfactory and oral dysfunctions, 5 systematic reviews on Guillen-Barré syndrome (GBS) and 8 articles on the sporadic manifestations like ocular signs and symptoms. The majority of the studies were classified as critically low or low in terms of quality. CONCLUSION Despite great heterogeneity in the current literature, neurological involvements are an important extra-pulmonary aspect of the COVID-19; most commonly in the form of general manifestations like headache and olfactory disturbances. Long-term effects of this virus on the nervous system must be a research priority for future references. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s41983-021-00366-5.
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Affiliation(s)
- Samad Shams Vahdati
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ala
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dara Rahmanpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Al-Hashel JY, Abokalawa F, Alenzi M, Alroughani R, Ahmed SF. Coronavirus disease-19 and headache; impact on pre-existing and characteristics of de novo: a cross-sectional study. J Headache Pain 2021; 22:97. [PMID: 34418950 PMCID: PMC8380111 DOI: 10.1186/s10194-021-01314-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 is caused by the severe acute respiratory syndrome coronavirus 2 Headache is a common symptom during and after Coronavirus disease-19. We aimed to study headache character in relation to COVID-19. METHODS This was a cross-sectional study. Patients who had Coronavirus disease-19, confirmed by reverse transcription polymerase chain reaction technique and presented to the headache clinic within 3 months after the onset of infections were identified to the study. Study included patients diagnosed as primary headache disorders according to The International Classification of Headache Disorders, 3rd edition. Participants were grouped into categories according to having previous or de novo headache. Descriptive data, paired sample t-test and the chi-squared test (X2) were used for statistical analyses of the data. RESULTS A total of 121 patients were included in this study. Their mean age was 35.29 + 9.54 and most of them were females (83.5%). Prior to Coronavirus disease-19 infections, 78 (64.5%) had migraine and 11(9.1%) experienced a tension-type headache while 32 (26.4) reported de novo headache post Coronavirus disease-19. Patient had significant increase in headache days 11.09 ± 8.45 post Coronavirus disease-19 compared with 8.66 ± 7.49 headache days before Coronavirus disease-19 infection (p < 0.006). Post Coronavirus disease-19, the usage of analgesic increased significantly by the patient with migraine (2.31 ± 1.65 vs 3.05 ± 2.09, p = 0.002) while the patient with tension type headache had statistically significant increase in severity (5.556 ± 1.86 vs 7 ± 2.25, p = 0.033) and frequency (7 ± 6.29 vs 12.72 ± 7.96, p = 0.006) of headache attacks. Bi-frontal and temporal headache are the most reported (40.6% each) headache site among de novo headache group. Patients younger than 40 years had longer duration of the headache attack (18.50 ± 16.44 vs 5.5 ± 9.07, p = 0.045) post COVID-19. Male patients compared to females (8.66 ± 1.15 versus 5.93 ± 2.01 p = 0.04) had more severe headache post Coronavirus disease-19. De novo headache resolved within 1 month in most of patients (65.3%). CONCLUSION Primary headache get worse after Coronavirus disease-19. De novo primary headache is frequent post Coronavirus disease-19 and resolve within 1 month. Headaches related to Coronavirus disease-19 are severe, present as migraine phenotype. Young male patients with Coronavirus disease-19 tend to have worse headache.
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Affiliation(s)
- Jasem Youssef Al-Hashel
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait
| | - Fathi Abokalawa
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
| | - Maram Alenzi
- Internal Medicine Department, Farwaniyah Hospital, Kuwait city, Kuwait
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Arabian Gulf Street, 13041 Sharq, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Neuropsychiatry department, Faculty of Medicine, Al-Minia University, P.O. Box 61519, Minia City, 61111 Egypt
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Göbel CH, Heinze A, Karstedt S, Morscheck M, Tashiro L, Cirkel A, Hamid Q, Halwani R, Temsah MH, Ziemann M, Görg S, Münte T, Göbel H. Clinical characteristics of headache after vaccination against COVID-19 (coronavirus SARS-CoV-2) with the BNT162b2 mRNA vaccine: a multicentre observational cohort study. Brain Commun 2021; 3:fcab169. [PMID: 34405142 PMCID: PMC8344581 DOI: 10.1093/braincomms/fcab169] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 causes the infectious disease COVID-19. Newly developed mRNA vaccines can prevent the spread of the virus. Headache is the most common neurological symptom in over 50% of those vaccinated. Detailed information about the clinical characteristics of this form of headache has not yet been described. The aim of the study is to examine in detail the clinical characteristics of headaches occurring after vaccination against COVID-19 with the BNT162b2 mRNA COVID-19 vaccine for the first time. In a multicentre observational cohort study, data on the clinical features and corresponding variables were recorded using a standardized online questionnaire. The questionnaire was circulated to 12 000 residential care homes of the elderly as well as tertiary university hospitals in Germany and the United Arab Emirates. The primary outcomes of this study are the clinical features of headache after vaccination. Comorbidities, treatment with medication and sociodemographic variables are also analysed. A total of 2349 participants reported headaches after vaccination with the BNT162b2 mRNA COVID-19 vaccine. Headaches occur an average of 18.0 ± 27.0 h after vaccination and last an average duration of 14.2 ± 21.3 h. Only 9.7% of those affected also report headaches resulting from previous vaccinations. In 66.6% of the participants, headache occurs as a single episode. A bilateral location is indicated by 73.1% of the participants. This is most often found on the forehead (38.0%) and temples (32.1%). A pressing pain character is indicated by 49.2% and 40.7% report a dull pain character. The pain intensity is most often moderate (46.2%), severe (32.1%) or very severe (8.2%). The most common accompanying symptoms are fatigue (38.8%), exhaustion (25.7%) and muscle pain (23.4%). Headaches after COVID-19 vaccination show an extensive complex of symptoms. The constellation of accompanying symptoms together with the temporal and spatial headache characteristics delimit a distinctive headache phenotype.
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Affiliation(s)
- Carl H Göbel
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Kiel Migraine and Headache Centre, Kiel, Germany
| | - Axel Heinze
- Kiel Migraine and Headache Centre, Kiel, Germany
| | - Sarah Karstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Kiel Migraine and Headache Centre, Kiel, Germany
| | | | | | - Anna Cirkel
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Kiel Migraine and Headache Centre, Kiel, Germany
| | - Qutayba Hamid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Malte Ziemann
- Institute of Transfusion Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Siegfried Görg
- Institute of Transfusion Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas Münte
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
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Abstract
PURPOSE OF REVIEW We define dehydration and its relationship to pain physiology including both primary and secondary headache disorders. RECENT FINDINGS Intravenous fluids administered for acute migraine attacks in an emergency department setting have not been shown to improve pain outcomes. However, increased intravascular volume before diagnostic lumbar puncture may reduce the frequency of post-lumbar puncture headache from iatrogenic spinal fluid leak. Maintenance of euhydration can help treat orthostatic and "coat-hanger" headache due to autonomic disorders. Similarly, prevention of fluid losses can mitigate secondary headaches provoked by dehydration such as cerebral venous thrombosis or pituitary apoplexy. Dehydration alone may cause headache, but oftentimes exacerbates underlying medical conditions such as primary headache disorders or other conditions dependent on fluid balance.
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Affiliation(s)
- Karissa N Arca
- Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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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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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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Oduro-Mensah E, Tetteh J, Adomako I, Adjei-Mensah E, Owoo C, Yawson AO, Oliver-Commey JA, Puplampu P, Samba A, Yawson AE, Lartey M. Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases. Ghana Med J 2020; 54:23-32. [PMID: 33976438 PMCID: PMC8087366 DOI: 10.4314/gmj.v54i4s.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana. METHODS Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16. RESULTS Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD's count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)]. CONCLUSION The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients. FUNDING None declared.
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Affiliation(s)
- Ebenezer Oduro-Mensah
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Isaac Adomako
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Evelyn Adjei-Mensah
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Christian Owoo
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- National COVID-19 Treatment Centre, University of Ghana Medical Centre, Accra, Ghana
- Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Anita O Yawson
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Joseph A Oliver-Commey
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- LEKMA Hospital, La Dadekotopon Municipality, Ghana Health Service, Accra, Ghana
| | - Peter Puplampu
- National COVID-19 Case Management Team, Ministry of Health, Accra, Ghana
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Pentecost Convention Centre- National CoOVID-19 Treatment Centre, Central Region, Ghana
| | - Ali Samba
- Department of Obstetrics & Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Martelletti P, Bentivegna E, Luciani M, Spuntarelli V. Headache as a Prognostic Factor for COVID-19. Time to Re-evaluate. ACTA ACUST UNITED AC 2020; 2:2509-2510. [PMID: 33263101 PMCID: PMC7690334 DOI: 10.1007/s42399-020-00657-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
Headache occurs in only about 13% of patients within the cohort of presenting COVID-19 symptoms. The hypothesis that such a painful symptomatic picture could be considered a prognostic factor for COVID-19 positive evolution or its trend of severity, or the co-generation of hyposmia/anosmia and/or hypogeusia/ageusia, needs robust epidemiological data, punctual pathophysiological demonstrations, and a detailed comparative analysis on drug–drug interactions (DDIs).
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
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