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MADRID — About 1 out of 5 patients who suffered from headaches in the initial phase of COVID-19 experienced chronic headaches throughout the day in an article that was published in Cephalalgia. The more intense the headache’s intensity in the acute phase more likely it will persist.

The study, conducted with the help of members of members of the Headache Study Group of the Spanish Society of Neurology (GECSEN) examined the development of headache in over 800 Spanish patients. As they observed that increased intensity of headaches in the acute phase was related to a longer time of suffering, the study recommended quickly evaluating patients who suffered from COVID-19 and then suffer from chronic headache.

Long-term Evolution Unknown

Headache is an atypical manifestation of COVID-19, however its long-term development remains unclear. The purpose in this research was to assess the duration of headache over time in patients who developed this symptom in an acute stage of COVID-19.

The enrollment process for this multicenter study began in March and April of 2020. The 905 patients recruited came from six level 3 institutions in Spain. The patients all underwent nine months of neurologic follow-up.

The median age of the patients was 51 years old, 66.5 percent of them were women and more than half (52.7 percent) were suffering from primary headache. A majority of patients needed hospitalization (50.5 percent) while the rest received treatment as non-inpatients. The most commonly reported headache type was an holocranial (67.8 percent) with intense intensity (50.6 percent).

Persistent Headache Common

In the 96.6 percent of cases for that data was accessible, the mean length of the headache was 14 days. The headache lasted for 1 month in 31.1 percent of patients. for 2 months at 21.5 percent and 3 months in 19 percentage, at 6 month in 16.8 percent, and at 9 months, 16.0 percentage.

“The mean duration of COVID-19 headaches is approximately 2 days,” David Garcia Azorin, MD, PhD, an active member of the Spanish Society of Neurology and one of the co-authors on the study, explained to Medscape’s Spanish edition. “However, almost 20% of patients have the headache for more than. If it is still present after two months, the headache tends to develop into an ongoing pattern of daily headache.” Garcia Azorin is a neurologist and clinical researcher at the Headache Unit of the Hospital Clinico Universitario in Valladolid, Spain.

“So If the pain isn’t going away it’s crucial to take advantage of the time available and treat the patient during the timeframe between 6 and twelve weeks.” the doctor continued. “To achieve this, the best choice is to implement preventive measures to ensure that patients be more likely to getting better.”

The participants in the study who had headaches that lasted after 9 months were more mature and mostly female. The risk of developing headaches was lower for women. have suffered from pneumonia, or to have suffered from the pain of stabbing, photophobia or Phonophobia. They said that their headache increased when they engaged in physical activities, but it was less often was it manifested in the throbbing headache.

Secondary Tension Headaches

However, Jaime Rodriguez Vico, MD director of the Headache Unit at the Jimenez Diaz Foundation Hospital in Madrid said in the Medscape Spanish edition that, based on his study of cases one of the most striking features in post-COVID-19-related headaches “in the general sense are secondary and they have similarities to tension-related headaches which patients are able to distinguish from other types of headache. When patients suffer from migraine frequently, we can tell the presence of the trigger. This means that more migraines, and even more extreme ones, too can be caused.”

He continued to say, “Generally, post-COVID-19 headache typically lasts between 1 and 2 weeks, but we’ve also seen instances of it lasting for several months or even one year, with recurring everyday headache. These cases that are more persistent may be related to a different type of pathology which can make them more prone to become chronic and recurring in a different form of primary headache referred to as new chronic headache.”

Primary Headache Exacerbation

Garcia Azorin pointed out that it’s not unusual for people with a primary headaches the severity of their headache increases when they are infected with SARS-CoV-2. Many people can differentiate the headache that is associated with the illness from their typical headaches because, after being infected, their headaches become typically frontal, achy, and persistent.

“Having an prior experience of headache is one of the causes that increase the chance that a headache that occurs when suffering from COVID-19 may be persistent,” he noted.

The study also revealed that most of the time patients suffering from chronic headache for 9 months or more experienced headaches that resembled migraines.

For headaches that occur in those who suffer for more than nine months of age, “based on our research it appears that the course of treatment is different,” said Rodriguez. “Our group’s numbers are distorted due to the quantity of migraine cases we track, which is why we have our large number of migraine sufferers who’ve got worse. Similar thing happens with COVID-19 vaccinations. Migraine is a multigenic disorder with multiple variations and the pathophysiology is just beginning to understand. This is the reason why the patient with one condition is different from the other. It’s a huge challenge,” He added.

Infections are a frequent reason for chronic or acute headaches. The persistent headache following an infection could result from the illness becoming chronic, like in certain forms of chronic meningitis like tuberculous meningitis. It could also be due to the persistent of a specific reaction and the activation of our immune system, or to the discovery or worsening of the primary headache that is associated in the course of the illness, explained Garcia Azorin.

“Likewise there are individuals who have a genetic predisposition for headaches, which is the result of a polygenic and multifactorial disorder, for instance, an individual trigger like an infection or trauma to drinking alcohol can trigger headaches like a migraine” the doctor said.

Giving Prognosis and Treatment

Certain aspects can provide an indication of how long the headache will be. The study’s univariate analysis showed that age, female sex, headache intensity, pressure-like quality, the presence of photophobia/phonophobia, and worsening with physical activity were associated with headache of longer duration. However, in the multivariate analysis only headache intensity during the acute phase was statically relevant (hazard rate, 0.655; 95% C.I. 0.582 + 0.737; P > .001).

If asked if they were planning to continue their study, Garcia Azorin commented, “The principal questions that have come up from this research have been most importantly”Why do headaches occur why does it happen?’ and how can it be dealt with or prevented? To answer those questions we’re studying how pain can be caused by factors that could cause a person to be more susceptible and what changes could be caused by it.”

Additionally, various treatments which could enhance the patient’s outcomes are being investigated, since the treatment to date is based on the primary pain characteristic.

In any case, doctors treat post-COVID-19-related headaches according to how similar their symptoms are to other headaches primary. “Given the negative impact that headaches can have on the health it is imperative for studies that are controlled on the possibility of treatments and their efficacy,” noted Patricia Pozo Rosich, MD, PhD as co-author of the study.

“We as members of the Spanish Society of Neurology truly believe that if patients could have this condition properly addressed at the beginning and they would be able to avoid a number of the issues that can occur when the problem becomes persistent,” she concluded.

Rodriguez and Garcia Azorin as well as Rodriguez have not revealed any financial transactions with them.

Cephalalgia. Published online on February 15, 2022. Abstract

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