The headache or headache is one of the manifestations of infection with the new coronavirus , SARS-CoV-2. Some medical organisms consider it the third most frequent global symptom and the features that differentiate it from other types of headache, the implications on the prognosis and the most effective treatments are becoming better known.
“It is a frequent and annoying symptom and, if an adequate medical history is made, it has specific characteristics .” This is how Jesus Porta Etessam, vice president of the Spanish Neurology Society (SEN) , head of the Neurology section of the San Carlos Clinical Hospital , Madrid, and professor at the Faculty of Medicine of Madrid, summarizes the role of headache in Covid-19. the Complutense University of Madrid . But he adds a relevant nuance: “Almost all virus infections can cause headaches and it is difficult to define whether it is really due to a SARS-CoV-2 infection or is due to another infection.”
Neurological symptoms are, according to David García Azorín, member of the SEN and neurologist at the Hospital Clínico de Valladolid , “the most frequent extrapulmonary manifestations of coronavirus infection”. And, among them, the most common are headache – which affects between 40 and 60% of symptomatic patients with Covid-19-, muscle pain (myalgia) and loss of smell and taste (anosmia and dysgeusia) .
Types of Covid-19 headache
Porta Etessam has directed a very enlightening study that has had the participation of different Spanish researchers -including García Azorín-, which has recently been published in the journal Headache . It describes four types of headaches associated with Covid-19 in healthcare professionals:
1. Headache typical of Covid-19
The specific headache associated with Covid-19 is characterized, above all, by the following features:
It gets worse with exertion .
Increase with head movements .
It can wake the patient up at night.
It is oppressive in character .
Its location is variable .
García Azorín has participated in a subsequent study, this time led by the Hospital Clínico de Valladolid, which provides additional data: “In some patients it resembles a tension-type headache , that is, bilateral, oppressive, continuous; while in another important percentage of cases the pain has characteristics similar to migraine , with discomfort to light stimuli (photophobia), hearing (phonophobia), feeling of nausea and accentuation of pain with the head rattling movement ”. The researcher clarifies that “a single headache pattern” has not been described, nor has “any characteristic that is exclusive to this infection” been observed.
2. Worsening of the primary headache
In patients who already suffered from headaches before contracting Covid-19, it is common for pain to worsen .
3. Headache produced by protective equipment
The use of masks and personal protective equipment (PPE) can cause headaches due to the constant pressure of these devices on specific areas of the head.
4.Headache from the stress situation
The stress and tension that many people are experiencing due to the pandemic, whether affected by the virus or not, is at the root of many headaches. “It is a more oppressive headache , usually frontal or bilateral (on both sides), it improves with activity, there is no nausea or vomiting and noises do not disturb,” explains Porta Etessam.
Since these are very different headaches, treatment should be as individualized as possible. Hence the importance, as stressed by the vice president of the SEN, of “making a differential diagnosis . ” For the treatment of the specific headache of Covid-19 “there is still little evidence,” adds the specialist. If it is a temporary pain, lasting about four or five days, the usual analgesics are used. “In those patients in whom the pain persists over time or have developed a post-Covid headache syndrome or post-infectious chronic headache, we are doing what are called anesthetic blocks and we are putting preventives a bit similar to those of migrainebecause it gives us the feeling that the clinical characteristics are similar ”. With these measures an efficiency of approximately 60% is achieved.
When it comes to an aggravation of the usual headache, if it is a migraine, the proper treatment of this type of headache will be applied. If it is a tension headache, in many cases neurologists choose to prescribe preventive treatment for the patient.
In headaches that are produced by stressful situations associated with Covid-19, specialists are opting for antidepressant drugs , especially from the group of tricyclics.
Finally, to avoid headaches due to the use of protective equipment, it is advisable to use masks that do not have as much traction. If necessary, a good idea may be to replace the rubber bands with straps that are tied behind the head , which allows to regulate the pressure. Those who use protective screens that cause discomfort can use lighter materials or systems that exert less pressure.
García Azorín clarifies the controversy that arose around ibuprofen during the months of confinement: “There was a certain degree of alarm about the use of anti-inflammatory drugs, which became practically banned. Later it has been seen that they do not pose a greater risk and that they can be taken if necessary ”.
Sign of a good or bad prognosis?
An issue that worries those affected is the duration of the headache associated with Covid-19 and the probability that it will become chronic. In general terms, the pain ends up subsiding, but there is a small percentage of cases (around 5%) in which it persists despite the resolution of the rest of the symptoms of the infection. The cause of this chronification is unknown, but we work with the hypothesis that “it could be due to the persistence of a certain degree of inflammation or to some problem that occurred during the course of the infection,” says the SEN member.
In any case, it does not seem that the headache is a poor prognostic sign of Covid-19, but rather that it would not influence or even be associated with a more benign course of the disease. The group from the Hospital Clínico de Valladolid has studied this aspect and has appreciated that, among the patients they have treated, the probability of dying during the infection was lower in those who suffered from headaches. These results have been published in The Journal of Headache and Pain .