Headache is an early symptom of Covid-19, often with migraine features

Headache occurs early-on and can persist

Dr David Garcia-Azorin presented results of a study of Covid-19 patients conducted at the Hospital Clinico Universitario de Valladolid, Spain from 8 March to 11 April 2020.^4,7 The aim was to estimate frequency of headache in Covid-19 patients and to characterize the phenotype of headache attributed to Covid-19. The study included 458 people aged over 18 years (mean age 51 years; 72% female) with confirmed Covid-19 infection and reporting headache (around 22% of all Covid-19 infections).⁴

Headache is a common non-respiratory symptom of Covid-19 that should not be overlooked

Headache was the first symptom of Covid-19 reported by 28% of people and 16% reported headache as the most bothersome symptom.⁷ Nearly 50% of people in this Covid-19 population had a prior history of headache (migraine 18%, tension-type headache 22%). The headache lasted for a median duration of 7 days (range 4-14 days) and persisted for 1 month for 13% of Covid-19 outpatients and 36% of hospitalized Covid-19 patients.

Headache, as a Covid-19 symptom, is long lasting with typical duration of 1 week but persisting for 1 month in some patients

Migraine features with Covid-19 headache

70% of Covid-19 patients with headache reported associated migraine features, which included: photophobia in 33% of patients, phonophobia (32%), avoidance of physical activity (67%), nausea (16%), vomiting (5%), worsening by head movement (31%).⁷ The quality of headache pain was described as pressing, throbbing, and stabbing and was most frequently bilateral and frontal although hospitalized Covid-19 patients more frequently had unilateral pain.

70% of Covid-19 patients with headache also report migraine symptoms, including photophobia, phonophobia, nausea, vomiting, avoidance of physical activity and worsening by head movement

Migraine experience in the Covid-19 era

The impact of Covid-19 on the health of people with migraine was explored in two other studies reported at #MTIS2020. Early lockdown measures could have affected migraine triggers, such as stress and anxiety, and the frequency of migraine.^8,9

During early 2020 (January to April) the proportion of most common migraine triggers – including stress, lack of sleep, neck pain and anxiety – decreased by a small degree compared with the same period in 2019 and 2018, as reported by users of the Migraine Buddy app (N = >150,000 worldwide).¹⁰ However, a small increase in migraine frequency was reported during the last 3 years, which could reflect a real increase, change in reporting habits, or change in make-up of the Migraine Buddy app users.

Conversely, a small cohort study of 592 patients in the Netherlands found a reduction in migraine for patients who completed a migraine headache e-diary for 1 month during lockdown (compared with 1 month pre-lockdown). Mean monthly migraine days decreased by 0.5 days, use of acute medication decreased by 0.5 days/month and general well-being improved.¹¹ The ongoing impact of Covid-19 on people with migraine needs further exploration in longitudinal studies.