Cross-sectional case-control studies (Blue)
Headache can be a manifestation of SARS-CoV-2 infection. In this study, the authors aimed to identify factors associated with headache in COVID-19 and headache characteristics. This case-control study included COVID-19 hospitalised patients with pneumonia during March 2020. Controls comprised COVID-19 patients without headache and cases COVID-19 patients with headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by a semi-structured telephone interview after discharge. Of a total of 379 COVID-19 patients, 48 (13%) developed headache. Among these, 30 (62%) were men and the median age was 57.9 (47-73) years. Headache was associated with younger age, fewer comorbidities and reduced mortality, as well as with lower levels of C-reactive protein, mild acute respiratory distress syndrome (ARDS) and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D-dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, while urea levels, beta-lactamase antibiotic treatment and hypertension were negatively associated with headache. COVID-19-associated headache characteristics were available in 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%), of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and in a holocranial location in 8/19 (42%) and temporal location in 7/19 (37%). The authors concluded that headache appears associated with more benign SARS-CoV-2 infection. COVID-19-associated headache appears an early symptom and with characteristics of headache attributed to systemic viral infection. Further research addressing the mechanisms underlying these findings is warranted.