Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20240027-en
Brazilian Journal of Pain
Review Article

Exploring the relationship between SARS-CoV-2 infection and headache: comprehensive systematic review

Explorando a relação entre infecção por SARS-CoV-2 e cefaleia: revisão sistemática abrangente

Guilherme Dutra; Felipe Martins; Eduardo Trota Chaves; Gabriela Garcia Torino; Noéli Boscato

Downloads: 0
Views: 9

Abstract

BACKGROUND AND OBJECTIVES: Addressing secondary headaches in SARS-CoV-2 infection is crucial for effective management and care optimization. This review aims to synthesize data on headache characteristics and the impact of pre-existing headache conditions on these symptoms in SARS-CoV-2 infection.

CONTENTS: A systematic search was conducted across multiple databases, including PubMed/Medline, Cochrane Collaboration, Web of Science, Scopus, LILACS, Embase, Open Grey, and Google Scholar, to identify studies on headache characteristics associated with SARS-CoV-2. The search focused on headache symptoms, characteristics, onset, duration, and response to treatment during and post-infection. Twenty-three studies met the inclusion criteria. Approximately 42.1% of individuals with SARS-CoV-2 reported headaches, resembling tension-type headaches and migraines. These headaches often manifested within the first three days of infection and could persist for up to four months. The data suggest that trigeminovascular activation and pro-inflammatory mediators play a significant role in headache pathogenesis, with pre-existing headache conditions exacerbating the symptoms. The importance of effective pain management strategies must be emphasized.

CONCLUSION: Headache is a prevalent symptom among SARS-CoV-2 infected individuals, with significant implications for patient care. The findings emphasize the importance of recognizing headache characteristics in SARS-CoV-2 management and suggest that tailored clinical approaches are essential for effective symptom relief.

Keywords

COVID-19; Headache; Pain; Pandemic; SARS-CoV-2

Resumo

JUSTIFICATIVA E OBJETIVOS: A abordagem das cefaleias secundárias na infecção pela SARS-CoV-2 é crucial para um manejo adequado e otimização do cuidado. Esta revisão tem como objetivo sintetizar os dados sobre as características da cefaleia e o impacto das condições pré-existentes de cefaleia sobre esses sintomas na infecção pela SARS-CoV-2.

CONTEÚDO: Uma pesquisa sistemática foi realizada em vários bancos de dados, incluindo: Pubmed/Medline, Cochrane Collaboration, Web of Science, Scopus, LILACS, Embase, Open Grey e Google Scholar, com o objetivo de identificar estudos sobre as características da cefaleia associadas à SARS-CoV-2. A pesquisa se concentrou nos sintomas, nas características, no início, na duração e na resposta ao tratamento da cefaleia durante e após a infecção. Vinte e três estudos atenderam aos critérios de inclusão. Aproximadamente 42,1% dos indivíduos com SARS-CoV-2 relataram dores de cabeça, semelhantes a dores de cabeça do tipo tensional e enxaquecas. Essas cefaleias geralmente se manifestavam nos primeiros três dias de infecção e podiam persistir por até quatro meses. Os dados sugerem que a ativação trigeminovascular e os mediadores pró-inflamatórios desempenham um papel importante na patogênese da cefaleia, com condições preexistentes de cefaleia exacerbando os sintomas. A importância de estratégias eficazes de controle da dor deve ser enfatizada.

CONCLUSÃO: A cefaleia é um sintoma prevalente entre os indivíduos infectados pela SARS-CoV-2, com significativas implicações no atendimento ao paciente. Os achados deste estudo enfatizam a importância do reconhecimento das características da cefaleia no manejo da SARS-CoV-2 e sugerem que abordagens clínicas personalizadas são essenciais para o alívio eficaz dos sintomas.

Palavras-chave

Cefaleia; COVID-19; Dor; Pandemia; SARS-CoV-2

References

1 International Classification of Orofacial Pain, 1st ed. (ICOP). Cephalalgia. 2020;40(2):129-221.

2 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed. (beta version). Cephalalgia. 2013 Jul;33(9):629-808.

3 López JT, García-Azorín D, Planchuelo-Gómez Á, García-Iglesias C, Dueñas-Gutiérrez C, Guerrero ÁL. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia. 2020;40(13):1432-42.

4 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.

5 Caronna E, Ballvé A, Llauradó A, Gallardo VJ, Ariton DM, Lallana S, López Maza S, Olivé Gadea M, Quibus L, Restrepo JL, Rodrigo-Gisbert M, Vilaseca A, Hernandez Gonzalez M, Martinez Gallo M, Alpuente A, Torres-Ferrus M, Pujol Borrell R, Alvarez-Sabin J, Pozo-Rosich P. Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia. 2020;40(13):1410-21.

6 Gonzalez-Martinez A, Fanjul V, Ramos C, Serrano Ballesteros J, Bustamante M, Villa Martí A, Álvarez C, García Del Álamo Y, Vivancos J, Gago-Veiga AB. Headache during SARS-CoV-2 infection as an early symptom associated with a more benign course of disease: a case-control study. Eur J Neurol. 2021;28(10):3426-36.

7 Porta-Etessam J, Matías-Guiu JA, González-García N, Gómez Iglesias P, Santos-Bueso E, Arriola-Villalobos P, García-Azorín D, Matías-Guiu J. Spectrum of headaches associated with SARS-CoV-2 infection: study of healthcare professionals. Headache. 2020;60(8):1697-704.

8 Pohl H, Gantenbein AR. COVID-19 and Headaches. Praxis (Bern 1994). 2021;110(4):201–6.

9 World Health Organization. Clinical management Clinical management Living guidance COVID-19. 2021B. 2021;16-44. https://www.who.int/emergencies/diseases/novel-coronavirus-2019?adgroupsurvey={adgroupsurvey}&gclid=CjwKCAjwsvujBhAXEiwA_UXnAGX3euiMPF0lP0N3cvQsMMA7ynisYTWTDx8rHa6Vvc_Lwvbqt9aTNRoCR0EQAvD_BwE

10 Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20.

11 Emodi-Perlman A, Eli I, Smardz J, Uziel N, Wieckiewicz G, Gilon E, Grychowska N, Wieckiewicz M. Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID-19 Pandemic-Concomitant Research in Two Countries. J Clin Med. 2020;9(10):3250.

12 Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.

13 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3(3):e123-30.

14 Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P, Mu P. Conducting systematic reviews of association (etiology): The Joanna Briggs Institute’s approach. Int J Evid Based Healthc. 2015;13(3):163-9.

15 Barut BÖ, Ulutaş S, Şahbaz G, Çelik A, Kara T, Öngörü P. COVID-19 related headache and its clinical characteristics. Neurol Asia. 2021;26(1):101–6. https://www.neurology-asia.org/articles/neuroasia-2021-26(1):101.

16 Bilge N, Kesmez C F, Alay H. The relationship of headache with inflammatory serum parameters and disease severity in COVID-19 patients. Duzce Med J. 2020;22 (Special Issue 1):44-50.

17 García-Azorín D, Trigo J, Talavera B, Martínez-Pías E, Sierra Á, Porta-Etessam J, Arenillas J F, Guerrero ÁL. Frequency and type of red flags in patients with covid-19 and headache: a series of 104 hospitalized patients. Headache. 2020a;60(8):1664-72.

18 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 Med. 2021;22(9):2092-9.

19 Kacem I, Gharbi A, Harizi C, Souissi E, Safer M, Nasri A, Letaief H, Akkari M, Hechaichi A, Mrabet S, Dhaouadi S, Ben Djebara M, Derouiche S, Gargouri A, Chahed M, Ben Alaya N, Gouider R. Characteristics, onset, and evolution of neurological symptoms in patients with COVID-19. Neurol Sci. 2021;42(1):39-46

20 Karadaş Ö, Öztürk B, Sonkaya AR, Taşdelen B, Özge A, Bolay H. Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6. Neurol Sci. 2021;42(5):1665-73.

21 Liu J, Li S, Liu J, Liang B, Wang X, Wang H, Li W, Tong Q, Yi J, Zhao L, Xiong L, Guo C, Tian J, Luo J, Yao J, Pang R, Shen H, Peng C, Liu T, Zhang Q, Wu J, Xu L, Lu S, Wang B, Weng Z, Han C, Zhu H, Zhou R, Zhou H, Chen X, Ye P, Zhu B, Wang L, Zhou W, He S, He Y, Jie S, Wei P, Zhang J, Lu Y, Wang W, Zhang L, Li L, Zhou F, Wang J, Dittmer U, Lu M, Hu Y, Yang D, Zheng X. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763.

22 Magdy R, Hussein M, Ragaie C, Abdel-Hamid HM, Khallaf A, Rizk HI, Dahshan A. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia. 2020;40(13):1422-31.

23 Osikomaiya B, Erinoso O, Wright KO, Odusola AO, Thomas B, Adeyemi O, Bowale A, Adejumo O, Falana A, Abdus-Salam I, Ogboye O, Osibogun A, Abayomi A. ‘Long COVID’: persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria. BMC Infect Dis. 2021;21(1):304.

24 Planchuelo-Gómez Á, Trigo J, de Luis-García R, Guerrero ÁL, Porta-Etessam J, García-Azorín D. Deep Phenotyping of Headache in Hospitalized COVID-19 Patients via Principal Component Analysis. Front Neurol. 2020;11:583870.

25 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51.

26 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapa JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D; “Pain in the Pandemic Initiative Collaborators”. Prevalence and characteristics of new-onset pain in COVID-19 survivours, a controlled study. Eur J Pain. 2021;25(6):1342-354.

27 Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E, Çağatay AA, Baykan B. Headache characteristics in COVID-19 pandemic-a survey study. J Headache Pain. 2020;21(1):121.

28 Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, Guerra L, Zaccaroni S, Cortelli P, Michelucci R, Liguori R. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci. 2020;41(8):2029-31.

29 Poncet-Megemont L, Paris P, Tronchere A, Salazard J P, Pereira B, Dallel R, Aumeran C, Beytout J, Jacomet C, Laurichesse H, Lesens O, Mrozek N, Vidal M, Moisset X. High Prevalence of headaches during covid-19 infection: a retrospective cohort study. Headache. 2020;60(10):2578-82.

30 Trigo J, García-Azorín D, Planchuelo-Gómez Á, Martínez-Pías E, Talavera B, Hernández-Pérez I, Valle-Peñacoba G, Simón-Campo P, de Lera M, Chavarría-Miranda A, López-Sanz C, Gutiérrez-Sánchez M, Martínez-Velasco E, Pedraza M, Sierra Á, Gómez-Vicente B, Arenillas J F, Guerrero ÁL. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. J Headache Pain. 2020;21(1):94.

31 Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, Gaudy-Graffin C, Grammatico-Guillon L, Bernard L. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-63.

32 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100.

33 Leth S, Gunst JD, Mathiasen V, Hansen K, Søgaard O, Østergaard L, Jensen-Fangel S, Storgaard M, Agergaard J. Persistent symptoms in patients recovering from COVID-19 in Denmark. Open Forum Infect Dis. 2021;8(4):ofab042.

34 García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021;11(1):14674

35 Bolay H, Gül A, Baykan B. COVID-19 is a Real Headache! Headache. 2020;60(7):1415-21.

36 Belvis R. Headaches during COVID-19: my clinical case and review of the literature. Headache. 2020;60(7):1422-6.

37 Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. 2021;61(1):60-8.

38 Ashina S, Mitsikostas DD, Lee MJ, Yamani N, Wang SJ, Messina R, Ashina H, Buse DC, Pozo-Rosich P, Jensen RH, Diener HC, Lipton RB. Tension-type headache. Nat Rev Dis Primers. 2021;7(1):24.

39 Burch R. Migraine and tension-type headache: diagnosis and treatment. Med Clin North Am. 2019;103(2):215-33.

40 Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.

41 Garcia-Azorin D, Layos-Romero A, Porta-Etessam J, Membrilla JA, Caronna E, Gonzalez-Martinez A, Mencia ÁS, Segura T, Gonzalez-García N, Díaz-de-Terán J, Gallardo VJ, Gago-Veiga AB, Ballvé A, Trigo López J, Sastre-Real M, Llauradó A, Cornejo A, de Lorenzo Í, Guerrero-Peral Á, Pozo-Rosich P. Post-COVID-19 persistent headache: a multicentric 9-months follow-up study of 905 patients. Cephalalgia. 2021b;42(8):804-9.

42 Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17(11):1318-25.

43 Mutiawati E, Syahrul S, Fahriani M, Fajar JK, Mamada SS, Maliga HA, Samsu N, Ilmawan M, Purnamasari Y, Asmiragani AA, Ichsan I, Emran TB, Rabaan AA, Masyeni S, Nainu F, Harapan H. Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis. F1000Res. 2020;9:1316.

44 Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana J P, Alvarado-Arnez LE, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez A F, Paniz-Mondolfi A, Lagos-Grisales GJ, Ramírez-Vallejo E, Suárez JA, Zambrano LI, Villamil-Gómez WE, Balbin-Ramon GJ, Rabaan AA, Harapan H, Dhama K, Nishiura H, Kataoka H, Ahmad T, Sah R; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623.

45 Robbins MS. Diagnosis and management of headache: a review. JAMA. 2021;325(18):1874-85.

46 Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(1):34.

47 Khan J, Asoom LIA, Sunni AA, Rafique N, Latif R, Saif SA, Almandil NB, Almohazey D, AbdulAzeez S, Borgio J F. Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. Biomed Pharmacother. 2021;139:111557.

48 Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21(10):56.

49 Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622.

50 O’Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, Karamchandani U, Simms-Williams N, Cassambai S, Ardavani A, Wilkinson TJ, Hawthorne G, Curtis F, Kingsnorth A P, Almaqhawi A, Ward T, Ayoubkhani D, Banerjee A, Calvert M, Shafran R, Stephenson T, Sterne J, Ward H, Evans RA, Zaccardi F, Wright S, Khunti K. The prevalence and long-term health effects of long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis. EClinicalMedicine. 2022;55:101762.
 


Submitted date:
01/29/2024

Accepted date:
02/28/2024

678ac2aea9539565883149e4 brjp Articles

BrJP

Share this page
Page Sections