Frequency and phenotype of headache in covid-19: a study of 2194 patients

David García-Azorín, Álvaro Sierra, Javier Trigo, Ana Alberdi, María Blanco, Ismael Calcerrada, Ana Cornejo, Miguel Cubero, Ana Gil, Cristina García-Iglesias, Ana Guiomar Lozano, Cristina Martínez Badillo, Carol Montilla, Marta Mora, Gabriela Núñez, Marina Paniagua, Carolina Pérez, María Rojas, Marta Ruiz, Leticia Sierra, María Luisa Hurtado, Ángel Luis Guerrero Peral, David García-Azorín, Álvaro Sierra, Javier Trigo, Ana Alberdi, María Blanco, Ismael Calcerrada, Ana Cornejo, Miguel Cubero, Ana Gil, Cristina García-Iglesias, Ana Guiomar Lozano, Cristina Martínez Badillo, Carol Montilla, Marta Mora, Gabriela Núñez, Marina Paniagua, Carolina Pérez, María Rojas, Marta Ruiz, Leticia Sierra, María Luisa Hurtado, Ángel Luis Guerrero Peral

Abstract

To estimate the frequency of headache in patients with confirmed COVID-19 and characterize the phenotype of headache attributed to COVID-19, comparing patients depending on the need of hospitalization and sex, an observational study was done. We systematically screened all eligible patients from a reference population of 261,431 between March 8 (first case) and April 11, 2020. A physician administered a survey assessing demographic and clinical data and the phenotype of the headache. During the study period, 2194 patients out of the population at risk were diagnosed with COVID-19. Headache was described by 514/2194 patients (23.4%, 95% CI 21.7-25.3%), including 383/1614 (23.7%) outpatients and 131/580 (22.6%) inpatients. The headache phenotype was studied in detail in 458 patients (mean age, 51 years; 72% female; prior history of headache, 49%). Headache was the most frequent first symptom of COVID-19. Median headache onset was within 24 h, median duration was 7 days and persisted after 1 month in 13% of patients. Pain was bilateral (80%), predominantly frontal (71%), with pressing quality (75%), of severe intensity. Systemic symptoms were present in 98% of patients. Headache frequency and phenotype was similar in patients with and without need for hospitalization and when comparing male and female patients, being more intense in females.Trial registration: This study was supported by the Institute of Health Carlos III (ISCIII), code 07.04.467804.74011 and Regional Health Administration, Gerencia Regional de Salud, Castilla y Leon (GRS: 2289/A/2020).

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Flow diagram. Number of patients that were identified, screened, included, and excluded, with the specific reasons for non-participation.
Figure 2
Figure 2
Frequency of headache in the entire sample and in the groups of patients managed in primary care and hospital care settings. ITT Intention-to-treat. PP Per protocol.

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