Frequency and Type of Red Flags in Patients With Covid-19 and Headache: A Series of 104 Hospitalized Patients

David García-Azorín, Javier Trigo, Blanca Talavera, Enrique Martínez-Pías, Álvaro Sierra, Jesús Porta-Etessam, Juan F Arenillas, Ángel L Guerrero, David García-Azorín, Javier Trigo, Blanca Talavera, Enrique Martínez-Pías, Álvaro Sierra, Jesús Porta-Etessam, Juan F Arenillas, Ángel L Guerrero

Abstract

Objective: In this study, we aimed to evaluate the frequency of the main red flags in patients with headache who do have Covid-19.

Background: Headache is one of the most frequent neurologic symptoms of Coronavirus disease 2019 (Covid-19). Diagnosis of secondary headache disorders is still based on the presence of red flags.

Design and methods: Cross-sectional study of hospitalized patients with confirmed Covid-19 disease. We interrogated every patient about the presence of headache and if so, a headache expert conducted a structured interview assessing the presence and type of the main red flags. We evaluated the presence of laboratory abnormalities on admission.

Results: We screened 576 consecutive patients, 130/576 (22.6%) described headache, and 104 were included in the study. Mean age of patients was 56.7 (standard deviation: 11.2) and 66/104 (63.4%) were female. Red flags concerning prior medical history were present in 79/104 (76.0%) cases, and those related to the headache itself were observed in 99/104 (95.2%) patients. All patients 104/104 (100%) described systemic symptoms and 86/104 (82.7%) some neurologic symptoms. Laboratory results were abnormal in 98/104 (94.2%) cases. The most frequent red flags were fever, in 93/104 (89.4%) patients, cough, in 89/104 (85.6% cases), and increased C-reactive protein in 84/100 (84.0%) cases.

Conclusion: In patients with Covid-19 that described the headache red flags were present in most cases. There was not any universal red flag, being necessary the comprehensive evaluation of all of them.

Keywords: Covid-19; coronavirus; diagnosis; headache; neurology.

© 2020 American Headache Society.

Figures

Fig. 1
Fig. 1
Headache onset in the course of Covid‐19 disease. Number of days after the first Covid‐19 symptom in which headache started. Kaplan‐Meier 1‐minus survival curve (n = 104).
Fig. 2
Fig. 2
Most common red flags in hospitalized patients with Covid‐19 disease and headache.

References

    1. World Health Organization . Director‐General's Opening Remarks at the Media Briefing on COVID‐19. Geneva: World Health Organization; 2020. Available at . Accessed May 21, 2020.
    1. World Health Organization . Coronavirus Disease (COVID‐19). Situation Report – 121. Available at . Accessed May 21, 2020.
    1. Klein BC, Busis NA. COVID‐19 is catalyzing the adoption of teleneurology. Neurology. 2020;94:903‐904.
    1. Chowdhury D, Datta D. Managing migraine in the times of COVID‐19 pandemic. Ann Indian Acad Neurol. 2020;23(Suppl. 1):S33‐S39.
    1. Silvestro M, Tessitore A, Tedeschi G, Russo A. Migraine in the time of COVID‐19. Headache. 2020;60:988‐989.
    1. Belvis R. Headaches during COVID‐19: My clinical case and review of the literature. Headache. 2020. doi: .
    1. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708‐1720.
    1. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:e201127.
    1. Bolay H, Gül A, Baykan B. COVID‐19 is a real headache. Headache. 2020. doi: .
    1. World Health Organization . Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (2019‐ nCoV) Infection is Suspected: Interim Guidance. 2020. Available at . Accessed May 21, 2020.
    1. World Health Organization . Coronavirus Disease (COVID‐19) Technical Guidance: Laboratory Testing for 2019‐nCoV in Humans. Available at . Accessed May 16, 2020.
    1. Ministry of Health . Technical Documents. Hospital Management of COVID‐19. Version March 19, 2020. Available at . Accessed May 21, 2020.
    1. Headache Classification Committee of the International Headache Society (IHS) . The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1‐211.
    1. Nye BL, Ward TN. Clinic and emergency room evaluation and testing of headache. Headache. 2015;55:1301‐1308.
    1. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice. SNNOOP10 list. Neurology. 2019;92:134‐144.
    1. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med. 2007;4:e296.
    1. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: A systematic review. Stroke. 2009;40:3393‐3395.
    1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community‐acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Disease Society of America. Am J Respir Crit Care Med. 2019;200:e45‐e67.
    1. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID‐19 infection. Clin Chem Lab Med. 2020;58:1131‐1134.
    1. Filler L, Akhter M, Nimlos P. Evaluation and management of emergency department headache. Semin Neurol. 2019;39:20‐26.
    1. Giamberardino MA, Affiaitati G, Costantini R, et al. Acute headache management in emergency department. A narrative review. Intern Emerg Med. 2015;1:109‐117.
    1. Chassé M, Fergusson DA. Diagnostic accuracy studies. Semin Nucl Med. 2019;49:87‐93.
    1. Godwin SA, Cherkas DS, Panagos PD, et al. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2019;74:e41‐e74.
    1. GBD 2016 Neurology Collaborators . Global, regional, and national burden of neurological disorders, 1990‐2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:459‐480.
    1. Atlas 2018 About the Impact and Situation of Migraine in Spain. Seville: Editorial Universidad de Sevilla; 2018. ISBN: 978‐84‐472‐2832‐4.
    1. National Epidemiologic Surveillance Network . Daily Report on the COVID‐19 Situation. Report number 31, March 14th, 2020. Available at . Accessed May 19, 2020.
    1. Giollo A, Adami G, Gatti D, et al. Coronavirus disease 19 (Covid‐19) and non‐steroidal anti‐inflammatory drugs (NSAID). Ann Rheum Dis. 2020;2020‐217598.
    1. Maassen Van den Brink A, de Vries T, Jan Danser AH. Headache medication and the COVID‐19 pandemic. J Headache Pain. 2020;21:38.
    1. Lechien JR, Chiesa‐Estomba CM, de Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild‐to‐moderate forms of the coronavirus disease (COVID‐19): A Multicenter European Study. Eur Arch Otorhinolaryngol. 2020;277:2251‐2261.
    1. Beltrán‐Corbellini A, Chico‐García JL, Martínez‐Poles J, et al. Acute‐onset smell and taste disorders in the context of COVID‐19: A pilot multicentre polymerase chain reaction based‐control study. Eur J Neurol. 2020. doi:.
    1. Angelo Vaira L, Deiana G, Fois AG, et al. Objective evaluation of anosmia and ageusia in COVID‐19 patients: Single‐center experience on 72 cases. Head Neck. 2020;42:1252‐1258.

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