Brain Structural Abnormalities in Patients with Post-COVID-19 Headache

Introduction: The clinical manifestations of the COVID-19 pandemic are heterogeneous and may include various symptoms (gastrointestinal, musculoskeletal, neurological). Approximately 25% of patients report headache as a neurological symptom, making it the fifth most common symptom. These headaches may arise from structural brain changes associated with the infection.

Purpose: This study aims to identify the structural abnormalities observed in brain MRI that correlate with chronic headaches in patients who had COVID-19 infection.

Methods: The study included 30 patients with post-COVID-19 headaches and 30 control patients with no history of COVID-19. Demographic characteristics were analyzed using t-tests and chi-square tests. MRI findings were categorized into six types: cortical atrophy, white matter lesions, vascular lesions, lacunar lesions, vascular encephalopathy, and sinusitis. Differences in MRI findings between the two groups were evaluated using chi-square tests. Secondary outcomes included the analysis of symptoms accompanying headaches, diagnoses following MRI, and treatments applied.

Study Overview

• Status: Completed
• Conditions: MRI; COVID-19; Headache
• Intervention / Treatment: Other: Observational Study - No intervention

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• Hungary
  • Budapest, Hungary, 1032
    • Szent Margit Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of adult patients (≥18 years) with persistent headaches following COVID-19 infection who were referred for brain MRI to investigate potential structural abnormalities. A control group of individuals without a history of COVID-19 infection or chronic headaches was included for comparison. Exclusion criteria included prior neurological diseases, recent head trauma, and MRI contraindications.

Description

Inclusion Criteria:

• Age ≥18 years
• History of COVID-19 infection
• Persistent headache following COVID-19 infection
• Brain MRI requested by the attending physician

Exclusion Criteria:

• Prior neurological disease or disorder
• MRI contraindications (e.g., pacemaker, metal implants, claustrophobia)

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Post-COVID-19 Headache Group; Participants in this group had a history of COVID-19 infection and developed persistent headaches afterward. They underwent brain MRI to assess potential structural abnormalities. Exclusion criteria included pre-existing neurological disorders or other conditions that could explain the headaches.	Other: Observational Study - No intervention; This is an observational study evaluating brain structural abnormalities in post-COVID headache patients. No experimental intervention is applied.
Control Group; Participants in this group had no history of COVID-19 infection and no reported chronic headaches or neurological conditions. They underwent brain MRI for unrelated medical reasons and served as a comparison group to evaluate the prevalence of structural brain abnormalities in post-COVID headache patients.	Other: Observational Study - No intervention; This is an observational study evaluating brain structural abnormalities in post-COVID headache patients. No experimental intervention is applied.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants with Specific Structural Brain Abnormalities Observed on MRI	Brain MRI scans were analyzed to determine the number of participants with specific structural abnormalities, including white matter lesions, cortical atrophy, vascular encephalopathy, lacunar infarcts, and sinusitis. Each abnormality was evaluated separately, and the number of participants affected by each type was recorded.	From September 2020 to December 2022

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Reporting Additional Symptoms Associated with Post-COVID-19 Headache	The number of participants experiencing symptoms such as dizziness, cognitive dysfunction, and visual disturbances was recorded. Each symptom was assessed separately and reported as the number of affected participants.	From September 2020 to December 2022
Number of Participants Diagnosed with Specific Conditions After MRI	Following MRI evaluation, the number of participants diagnosed with specific conditions (e.g., migraines, post-COVID headache, vestibular syndrome) was recorded. Each diagnosis was evaluated and reported separately.	From September 2020 to December 2022
Number of Participants Receiving Specific Treatment Approaches for Post-COVID-19 Headache	The number of participants receiving pharmacological treatments (e.g., cognitive enhancers, antidepressants) and lifestyle modifications was recorded. Each treatment approach was assessed separately and reported as the number of affected participants.	From September 2020 to December 2022

Collaborators and Investigators

• Sponsor: University of Pecs

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2020
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): December 31, 2022

Study Registration Dates

• First Submitted: February 11, 2025
• First Submitted That Met QC Criteria: February 11, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 13, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: MRI; COVID-19; brain; headache; white matter lesion
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Respiratory Tract Infections; Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Pneumonia, Viral; Pneumonia; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; COVID-19; Headache
• Other Study ID Numbers: IG/296-1/2025/1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

Drug and device information, study documents

• product manufactured in and exported from the U.S.: No