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García-Azorín D, Santana-López L, Lozano-Alonso JE, Ordax-Díez A, Vega-Alonso T, Macias Saint-Gerons D, González-Osorio Y, Rojo-Rello S, Eiros JM, Sánchez-Martínez J, Sierra-Mencía Á, Recio-García A, Martín-Toribio A, Sanz-Muñoz I, Guerrero-Peral ÁL. Factors associated to the presence of headache in patients with influenza infection and its consequences: a 2010-2020 surveillance-based study. J Headache Pain 2024; 25:18. [PMID: 38331709 PMCID: PMC10854039 DOI: 10.1186/s10194-024-01728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
Headache is a common symptom of influenza infection; however, its causes and consequences remain uncertain. In this manuscript, we analyzed which demographic and clinical factors were associated with the presence of headache during the course of influenza infection and whether patients with headache had a different prognosis, evaluated by need of hospitalization, sick leave or school absenteeism. The influence study (NCT05704335) was an observational study that analyzed data routinely collected from the Health Sentinel Network between 2010 and 2020. During the study period, 7832 cases were considered, among which, 5275 (67.4%) reported headache. The presence of headache was independently associated with myalgia (2.753; 95%CI: 2.456-3.087, P < 0.001), asthenia (OR: 1.958; 95%CI: 1.732-2.214, P < 0.001), shivering (OR: 1.925; 95%CI: 1.718-2.156, P < 0.001), nasopharyngeal erythema (OR: 1.505; 95%CI: 1.293-1.753, P < 0.001), fever (OR: 1.469; 95%CI: 1.159-1.861; P = 0.001), sudden onset of symptoms (OR: 1.380; 95%CI: 1.120-1.702, p = 0.004), female sex (OR: 1.134; 95%CI: 1.023-1.257, P = 0.018), and gastrointestinal symptoms (OR: 1.169; 95%CI: 1.039-1.315; P = 0.01). Patients with headache had a sex and age adjusted lower odds of being referred to the hospital (OR: 0.463; 95%CI: 0.264-0.812, P = 0.007) and a higher odd of having a sick leave and/or school absenteeism (absenteeism (OR: 1.342; 95%CI: 1.190-1.514, P < 0.001). In conclusion, the presence of headache seems associated with symptoms caused by the innate immune response. These findings support a headache pathophysiology linked with the innate immune response. Due to the potential negative consequences and its treatable nature, clinicians should systematically evaluate it and, whenever necessary, treat it too.
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Affiliation(s)
- David García-Azorín
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain.
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain.
| | - Laura Santana-López
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
| | - José Eugenio Lozano-Alonso
- Fundación Instituto de Estudios de Ciencias de La Salud de Castilla y León, ICSCYL, Valladolid, Soria, Spain
| | - Ana Ordax-Díez
- Fundación Instituto de Estudios de Ciencias de La Salud de Castilla y León, ICSCYL, Valladolid, Soria, Spain
| | - Tomas Vega-Alonso
- Dirección General de Salud Pública, Consejería de Sanidad, Junta de Castilla y León, Valladolid, Spain
| | - Diego Macias Saint-Gerons
- Department of Medicine, University of Valencia; INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Yésica González-Osorio
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
| | - Silvia Rojo-Rello
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José M Eiros
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- National Influenza Centre, Valladolid, Spain
| | | | - Álvaro Sierra-Mencía
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
| | - Andrea Recio-García
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
| | - Alejandro Martín-Toribio
- Fundación Instituto de Estudios de Ciencias de La Salud de Castilla y León, ICSCYL, Valladolid, Soria, Spain
- National Influenza Centre, Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- National Influenza Centre, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Department of Neurology, Headache Unit, Hospital Clínico Universitario de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Hospital Clínico Universitario de Valladolid, Rondilla Santa Teresa Streat S/N, Edificio Rondilla, 47010, Valladolid, Spain
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García-Azorín D, Santana-López L, Lozano-Alonso JE, Ordax-Díez A, González-Osorio Y, Rojo-Rello S, Eiros JM, Sánchez-Martínez J, Recio-García A, Sierra-Mencía Á, Sanz-Muñoz I, Guerrero-Peral ÁL. InfluenCEF study: Clinical phenotype and duration of headache attributed to influenza infection. Cephalalgia 2023; 43:3331024231212900. [PMID: 37950674 DOI: 10.1177/03331024231212900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Headache is a frequent symptom of infections. We aimed to characterize the clinical phenotype and duration of headache attributed to influenza infection. METHODS Prospective cohort study done in 53 primary care centers between January and April 2023. Patients were included if they had a confirmed influenza diagnosis, were older than 15 years and had a new-onset headache. Patients' demographics, prior medical history, headache phenotype and duration, associated symptoms and patients' outcomes were assessed. The International Classification of Headache Disorders criteria for headache attributed to a systemic viral infection, migraine and tension-type headache were assessed. RESULTS Of the 478 patients 75 fulfilled eligibility criteria. The mean age was 43, 56% were men, and 27% had a prior headache history. The headache phenotype was a bilateral headache (52%), with frontal topography (48%), pressing quality (61%), moderate intensity, rhinorrhea (79%), nasal congestion (76%), and photophobia (59%). All patients fulfilled headache attributed to acute systemic viral infection criteria, 43% fulfilled migraine criteria and 31% tension-type headache criteria. The median duration of the headache was four (Inter-quartile range: two-six) days. CONCLUSION The clinical phenotype of headache attributed to influenza infection was similar to other infections, with more pronounced cranial autonomic symptoms. The headache was an early symptom and was self-limited within a few days.Trial Registration: The study protocol is registered in ClinicalTrial.gov (NCT05704335).
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Affiliation(s)
- David García-Azorín
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Laura Santana-López
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - José Eugenio Lozano-Alonso
- Dirección General de Salud Pública e Investigación, Desarrollo e Innovación, Gerencia Regional de Salud, Junta de Castilla y León, Valladolid, Spain
| | - Ana Ordax-Díez
- Dirección General de Salud Pública e Investigación, Desarrollo e Innovación, Gerencia Regional de Salud, Junta de Castilla y León, Valladolid, Spain
| | - Yésica González-Osorio
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Silvia Rojo-Rello
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José M Eiros
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- National Influenza Centre, Valladolid, Spain
| | - Javier Sánchez-Martínez
- National Influenza Centre, Valladolid, Spain
- Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León, ICSCYL, Soria, Spain
| | - Andrea Recio-García
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Álvaro Sierra-Mencía
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- National Influenza Centre, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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