COVID-19-associated headache: Difference between revisions

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__NOTOC__
__NOTOC__
{{COVID-19}}
{{SI}}
{{CMG}}; {{AE}} {{Fs}}
{{CMG}}; {{AE}} {{Fs}}  {{sali}}


{{SK}}  
{{SK}}  


==Overview==
==Overview==
The association between COVID-19 and [[headache]] was made in 2020. COVID-19 associated headache may be caused by [[SARS-CoV-2|SARS-CoV-2 virus]]. There is no established system for the [[classification]] of COVID-19 associated headache. The exact [[pathogenesis]] of [[headache]] in COVID 19 patients is not fully understood. It is thought that headache is the result of cytokine release, direct [[invasion]], metabolic disturbances, inflammation, dehydration, and hypoxia.                
The association between COVID-19 and headache was made in 2020. COVID-19 associated headache may be caused by the [[SARS-CoV-2|SARS-CoV-2 virus]]. There is no established system for the [[classification]] of COVID-19 associated headache. The exact [[pathogenesis]] of [[headache]] in COVID-19 patients is not fully understood. It is thought that [[Cluster headache|headache]] is the result of [[cytokine]] release, direct [[invasion]], metabolic disturbances, [[Cervicitis|inflammation]], [[dehydration]], and [[hypoxia]]. COVID-19-associated headache must be differentiated from other diseases that cause [[headache]], such as [[migraine]], [[tension-type headache]], [[Cluster headache (patient information)|cluster headache]], [[seizure]], [[meningitis]], [[encephalitis]], [[neurosyphilis]], [[Subarachnoid hemorrhage|SAH]], [[subdural hematoma]], [[brain tumor]], [[hypertensive encephalopathy]], [[brain abscess]], [[multiple sclerosis]], [[hemorrhagic stroke]], [[Wernicke's encephalopathy|Wernickes encephalopathy]], and [[drug toxicity]]. A positive history of [[fever]] and [[cough]] in addition to headache is suggestive of [[COVID]]-19-associated headache.                


==Historical Perspective==
==Historical Perspective==


* The association between COVID-19 and [[headache]] was made in 2020.
* The association between COVID-19 and [[headache]] was made in December, 2019 during the [[SARS-CoV-2]] [[outbreak]] initiated in Wuhan, Hubei Province, China.<ref name="pmid32563019">{{cite journal |vauthors=Meng X, Deng Y, Dai Z, Meng Z |title=COVID-19 and anosmia: A review based on up-to-date knowledge |journal=Am J Otolaryngol |volume=41 |issue=5 |pages=102581 |date=June 2020 |pmid=32563019 |pmc=7265845 |doi=10.1016/j.amjoto.2020.102581 |url=}}</ref>


==Classification==
==Classification==
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==Differentiating COVID-19-associated headache from other Diseases==
==Differentiating COVID-19-associated headache from other Diseases==
COVID-19-associated headache must be differentiated from other diseases that cause headache, such as: <ref name="pmid14503985">{{cite journal |vauthors= |title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage |journal=Ann. Clin. Biochem. |volume=40 |issue=Pt 5 |pages=481–8 |date=September 2003 |pmid=14503985 |doi=10.1258/000456303322326399 |url=}}</ref><ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }}</ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }}</ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }}</ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }}</ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }}</ref><ref name="pmid2769274">{{cite journal |vauthors=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J |title=Xanthochromia after subarachnoid haemorrhage needs no revisitation |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=7 |pages=826–8 |date=July 1989 |pmid=2769274 |pmc=1031927 |doi=10.1136/jnnp.52.7.826 |url=}}</ref><ref name="pmid15885053">{{cite journal |vauthors=Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R |title=Extra temporal involvement in herpes simplex encephalitis |journal=Eur. J. Neurol. |volume=12 |issue=6 |pages=475–9 |date=June 2005 |pmid=15885053 |doi=10.1111/j.1468-1331.2005.00999.x |url=}}</ref><ref name="pmid17109290">{{cite journal |vauthors=Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH |title=Beyond viruses: clinical profiles and etiologies associated with encephalitis |journal=Clin. Infect. Dis. |volume=43 |issue=12 |pages=1565–77 |date=December 2006 |pmid=17109290 |doi=10.1086/509330 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |date=May 2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid1941010">{{cite journal |vauthors=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population--a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |date=1991 |pmid=1941010 |doi=10.1016/0895-4356(91)90147-2 |url=}}</ref><ref name="pmid15447695">{{cite journal |vauthors=Kelman L |title=The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs |journal=Headache |volume=44 |issue=9 |pages=865–72 |date=October 2004 |pmid=15447695 |doi=10.1111/j.1526-4610.2004.04168.x |url=}}</ref><ref name="pmid26643378">{{cite journal |vauthors=Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M |title=Premonitory symptoms in migraine: A cross-sectional study in 2714 persons |journal=Cephalalgia |volume=36 |issue=10 |pages=951–9 |date=September 2016 |pmid=26643378 |doi=10.1177/0333102415620251 |url=}}</ref><ref>{{cite web | author=Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center | title=Cluster Headaches  |url=http://www.webmd.com/content/article/46/1826_50688.htm | date=October 2004 | publisher=WebMD | accessdate=2006-09-22}}</ref><ref name="pmid7888747">{{cite journal |vauthors=Drummond PD |title=Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome |journal=Clin. Auton. Res. |volume=4 |issue=5 |pages=273–85 |date=October 1994 |pmid=7888747 |doi=10.1007/BF01827433 |url=}}</ref><ref name="pmid16686902">{{cite journal |vauthors=Drummond PD |title=Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache |journal=Cephalalgia |volume=26 |issue=6 |pages=633–41 |date=June 2006 |pmid=16686902 |doi=10.1111/j.1468-2982.2006.01106.x |url=}}</ref><ref name="pmid2245469">{{cite journal |vauthors=Ekbom K |title=Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society |journal=Cephalalgia |volume=10 |issue=4 |pages=195–7 |date=August 1990 |pmid=2245469 |doi=10.1046/j.1468-2982.1990.1004195.x |url=}}</ref><ref name="pmid7697707">{{cite journal |vauthors=Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G |title=Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine |journal=Cephalalgia |volume=14 |issue=6 |pages=451–7; discussion 394–5 |date=December 1994 |pmid=7697707 |doi=10.1046/j.1468-2982.1994.1406451.x |url=}}</ref><ref name="pmid7515793">{{cite journal |vauthors=Jensen R, Fuglsang-Frederiksen A |title=Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population |journal=Electroencephalogr Clin Neurophysiol |volume=93 |issue=3 |pages=175–83 |date=June 1994 |pmid=7515793 |doi=10.1016/0168-5597(94)90038-8 |url=}}</ref>


* [[Migraine]]
* For further information about the differential diagnosis, [[COVID-19-associated headache differential diagnosis|click here]].
* [[Tension-type headache]]
* To view the differential diagnosis of COVID-19, [[COVID-19 differential diagnosis|click here]].
* [[Cluster headache]]
* [[Seizure]]
* [[Meningitis]]
* [[Encephalitis]]
* [[Neurosyphilis]]
* [[SAH]]
* [[Subdural hematoma]]
* [[Brain tumor]]
** [[Astrocytoma]]
** [[Oligodendroglioma]]
** [[Meningioma]]
** [[Hemangioblastoma]]
** [[Pituitary adenoma]]
** [[Schwannoma]]
** [[Primary CNS lymphoma]]
** [[Medulloblastoma]]
** [[Ependymoma]]
** [[Craniopharyngioma]]
** [[Pinealoma]]
** [[Brain metastasis]]
* [[Hypertensive encephalopathy]]
* [[Brain abscess]]
* [[Hemorrhagic stroke]]
* [[Wernicke's encephalopathy|Wernickes encephalopathy]]
* [[Drug toxicity]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==


*[[WHO]] reported that more than 462,801 people have been infected worldwide, more than 380,723 of which are outside of China.  
=== Incidence / Prevalence ===
*The [[incidence]]/[[prevalence]] of [[COVID-19]]-associated [[headache]] is still unknown.
 
*Guan et al. recently reported 13 percent of [[COVID-19]]-associated [[headache]] among 1099 laboratory-confirmed cases<ref name="pmid32315723">{{cite journal| author=Tu H, Tu S, Gao S, Shao A, Sheng J| title=Current epidemiological and clinical features of COVID-19; a global perspective from China. | journal=J Infect | year= 2020 | volume= 81 | issue= 1 | pages= 1-9 | pmid=32315723 | doi=10.1016/j.jinf.2020.04.011 | pmc=7166041 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32315723  }} </ref>.
*[[WHO]] reported that more than 462,801 people have been infected worldwide, more than 380,723 of which are outside of China.<ref name="pmid32315723">{{cite journal| author=Tu H, Tu S, Gao S, Shao A, Sheng J| title=Current epidemiological and clinical features of COVID-19; a global perspective from China. | journal=J Infect | year= 2020 | volume= 81 | issue= 1 | pages= 1-9 | pmid=32315723 | doi=10.1016/j.jinf.2020.04.011 | pmc=7166041 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32315723  }} </ref>
*The [[incidence]]/[[prevalence]] of COVID-19-associated headache is still unknown.
*Guan et al. recently reported 13 percent of COVID-19-associated headache among 1099 laboratory-confirmed cases.


===Age===
===Age===
There is insufficient information regarding age-specific [[prevalence]] or [[incidence]] of COVID-19-associated [[headache]].
 
* There is insufficient information regarding age-specific [[prevalence]] or [[incidence]] of COVID-19-associated headache.


===Gender===
===Gender===
There is insufficient information regarding gender-specific [[prevalence]] or [[incidence]] of COVID-19-associated [[headache]].
 
* There is insufficient information regarding gender-specific [[prevalence]] or [[incidence]] of COVID-19-associated headache.


===Race===
===Race===
There is insufficient information regarding race-specific [[prevalence]] or [[incidence]] of COVID-19-associated [[headache]].
 
* There is insufficient information regarding race-specific [[prevalence]] or [[incidence]] of COVID-19-associated headache.


==Risk Factors==
==Risk Factors==


* There are no established risk factors for COVID-19-associated [[headache]].
* There are no established [[Risk factor|risk factors]] for COVID-19-associated headache.


==Screening==
==Screening==


* There is insufficient evidence to recommend routine screening for COVID-19 associated headache.
* There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for [[COVID]]-19 associated headache.


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
* At this point [[natural history]] of [[COVID-19]]-associated [[headache]] is unknown.
* At this point, the [[natural history]] of [[COVID-19]]-associated [[headache]] is unknown.
* Further studies are needed to better understand the [[COVID-19]]-associated [[headache]].
* Further studies are needed to better understand the [[COVID-19]]-associated [[headache]].


===Complication===
===Complication===


* Patients with a history migraine may experience headache as their first symptom, these patients experience more severe headache and are more disabled by the infection compared with age‐matched cohorts.
* Patients with a history [[migraine]] may experience [[headache]] as their first [[symptom]], and these [[patients]] experience more severe [[headache]] and are more disabled by the [[HIV AIDS|infection]] compared with age‐matched [[cohorts]].
* Further studies are needed to better understand complication.  
* Further studies are needed to better understand [[complication]]<nowiki/>s.
* Larger retrospective studies are needed for evaluating the experience of COVID‐19 in patients with a history of a primary headache disorder.
* Larger retrospective studies are needed for evaluating the experience of [[COVID-19|COVID‐19]] in [[patients]] with a [[History and Physical examination|history]] of a primary [[headache]] disorder.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===


* The diagnosis of COVID-19-associated headache is based on the clinical presentation
* The [[diagnosis]] of COVID-19-associated [[headache]] is based on the [[clinical]] presentation.


* There are no established criteria for the diagnosis of COVID-19-associated headache.
* There are no established criteria for the diagnosis of COVID-19-associated headache.
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===History and Symptoms===
===History and Symptoms===


* The hallmark of COVID-19-associated headache is headache.  
* The hallmark of COVID-19-associated headache is [[headache]].  
 
* A positive history of [[fever]] and [[cough]] in addition to headache is suggestive of [[COVID]]-19-associated headache.
 
====Common Symptoms====


* A positive history of fever and cough in addition to headache is suggestive of COVID-19-associated headache.
*Common [[symptoms]] of COVID-19-associated [[headache]] are:
**[[Fever]]
**[[Shortness of breath]]
**[[Consciousness|Cognitive]] impairment
**[[Cough]]
**[[Fatigue]]
 
====Less Common Symptoms====
 
*Less common [[symptoms]] of COVID-19-associated [[headache]] are:
**[[Facial droop]]
**[[Myoclonus]]
**[[Dysarthria]]
**<nowiki/><nowiki/>[[Generalized seizure|S]]<nowiki/>[[Generalized seizure|eiz]]<nowiki/>[[Generalized seizure|ures]]
**[[Paralysis|P]]<nowiki/>[[Paralysis|ar]][[Paralysis|a]]<nowiki/>[[Paralysis|ly]][[Paralysis|sis]]
**[[Dizziness]]
**[[Sedation]]
**[[Comatose|Coma]]


===Physical Examination===
===Physical Examination===


* Patients with COVID-19-associated headache usually appear normal. Physical examination of patients with COVID-19-associated headache is usually remarkable for fever, cough, and malaise.
* Patients with [[COVID]]-19-associated [[headache]] usually appear normal.  
*Physical examination of patients with COVID-19-associated [[headache]] is usually remarkable for [[fever]], [[cough]], and [[malaise]].


===Laboratory Findings===
===Laboratory Findings===


* Additional diagnostic tests like blood chemistry and urine analysis may be needed to rule out other medical conditions.  
* Additional diagnostic tests like [[blood]] [[chemistry]] and [[urine]] [[analysis]] may be needed to rule out other [[medical]] conditions.  


* There are no diagnostic laboratory findings associated with COVID-19-associated headache.
* There are no diagnostic [[laboratory]] findings associated with [[COVID]]-19-associated [[headache]].


===Electrocardiogram===
===Electrocardiogram===


*There are no ECG findings associated with COVID-19-associated headache.
*There are no [[ECG]] findings associated with [[COVID]]-19-associated [[headache]].


===X-ray===
===X-ray===


*There are no x-ray findings associated with COVID-19-associated headache.
*There are no [[x-ray]] findings associated with COVID-19-associated [[headache]].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===


*There are no echocardiography/ultrasound  findings associated with COVID-19-associated headache.
*There are no [[echocardiography]]/[[ultrasound]] findings associated with [[COVID]]-19-associated headache.


===CT scan===
===CT scan===


*There are no CT scan findings associated with COVID-19-associated headache.
*There are no [[CT scan]] findings associated with COVID-19-associated headache.


===MRI===
===MRI===


*There are no MRI findings associated with COVID-19-associated headache.
*There are no [[MRI]] findings associated with COVID-19-associated headache.


===Other Imaging Findings===
===Other Imaging Findings===
Line 150: Line 151:


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with COVID-19-associated headache.
 
* There are no other diagnostic studies associated with [[COVID]]-19-associated headache.


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


* Medical therapy for COVID-assocaited-headache is still controversial<ref name="pmid32334062">{{cite journal| author=Zhang J, Xie B, Hashimoto K| title=Current status of potential therapeutic candidates for the COVID-19 crisis. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 59-73 | pmid=32334062 | doi=10.1016/j.bbi.2020.04.046 | pmc=7175848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32334062  }} </ref>.
* Medical [[therapy]] for [[COVID]]-assocaited-[[headache]] is still controversial.<ref name="pmid32334062">{{cite journal| author=Zhang J, Xie B, Hashimoto K| title=Current status of potential therapeutic candidates for the COVID-19 crisis. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 59-73 | pmid=32334062 | doi=10.1016/j.bbi.2020.04.046 | pmc=7175848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32334062  }} </ref><ref name="pmid32334535">{{cite journal |vauthors=MaassenVanDenBrink A, de Vries T, Danser AHJ |title=Headache medication and the COVID-19 pandemic |journal=J Headache Pain |volume=21 |issue=1 |pages=38 |date=April 2020 |pmid=32334535 |pmc=7183387 |doi=10.1186/s10194-020-01106-5 |url=}}</ref><ref name="pmid32171062">Fang L, Karakiulakis G, Roth M (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=32171062 Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?] ''Lancet Respir Med'' 8 (4):e21. [http://dx.doi.org/10.1016/S2213-2600(20)30116-8 DOI:10.1016/S2213-2600(20)30116-8] PMID: [https://pubmed.gov/32171062 32171062]</ref><ref name="pmid32198292">FitzGerald GA (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=32198292 Misguided drug advice for COVID-19.] ''Science'' 367 (6485):1434. [http://dx.doi.org/10.1126/science.abb8034 DOI:10.1126/science.abb8034] PMID: [https://pubmed.gov/32198292 32198292]</ref>
* The use of NSAIDs, who received treatment early in the disease causes worsening of COVID-19 symptoms according to some anecdotal evidences.13 Although, there is no clinical or population-data that confirm this risk.
* The use of [[NSAIDs]], who received [[treatment]] early in the [[disease]] causes worsening of [[COVID-19]] symptoms according to some anecdotal evidences.
*In March 11, 2020, Fang et al. reported the hypothesis that ibuprofen can increase the risk of developing severe and fatal COVID-19 since ibuprofen is known to upregulate ACE2 receptors<ref name="pmid32171062">Fang L, Karakiulakis G, Roth M (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=32171062 Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?] ''Lancet Respir Med'' 8 (4):e21. [http://dx.doi.org/10.1016/S2213-2600(20)30116-8 DOI:10.1016/S2213-2600(20)30116-8] PMID: [https://pubmed.gov/32171062 32171062]</ref>.
*In March 11, 2020, Fang et al. reported the hypothesis that [[ibuprofen]] (40 mg/kg/dose) can increase the risk of developing severe and fatal [[COVID-19]] since [[ibuprofen]] is known to upregulate ACE2 [[receptors]].
* In March 23, 2020, US FDA announced that it is not aware of any evidence that NSAIDs such as ibuprofen could worsen COVID-19<ref name="pmid32198292">FitzGerald GA (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=32198292 Misguided drug advice for COVID-19.] ''Science'' 367 (6485):1434. [http://dx.doi.org/10.1126/science.abb8034 DOI:10.1126/science.abb8034] PMID: [https://pubmed.gov/32198292 32198292]</ref>.
* In March 23, 2020, US [[FDA]] announced that it is not aware of any evidence that [[NSAIDs]] such as [[ibuprofen]] could worsen [[COVID-19]].
* The European Medicines Agency and World Health Organization (WHO) have not yet recommended that NSAIDs be avoided.
* The [[European Medicines Agency]] and [[World Health Organization]] (WHO) have not yet recommended that NSAIDs be avoided.
* Despite this recommendation, as a precautionary measure many providers are avoiding NSAIDs in patients with COVID-19.
* Despite this recommendation, as a precautionary measure many providers are avoiding [[NSAIDs]] in patients with [[COVID-19]].
* In practice, the decision to continue or stop NSAIDs in patients with COVID-19 is made in collaboration between the treating physician and the patient, after a brief discussion on the limited available evidence.
* In practice, the decision to continue or stop [[NSAIDs]] in patients with [[COVID-19]] is made in collaboration between the treating physician and the patient, after a brief discussion on the limited available evidence.
* More data are needed before broad recommendations are made.
* More data are needed before broad recommendations are made.


===Surgery===
===Surgery===


*Surgical intervention is not recommended for the management of COVID-19-associated headache.
*[[Surgical]] intervention is not recommended for the management of [[COVID]]-19-associated headache.


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of COVID-19 associated headache.
 
* There are no established measures for the [[primary prevention]] of COVID-19 associated headache.


===Secondary Prevention===
===Secondary Prevention===


* There are no established measures for the secondary prevention of COVID-19-associated headache.
* There are no established measures for the [[secondary prevention]] of COVID-19-associated headache.


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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List of terms related to COVID-19-associated headache

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Syed Musadiq Ali M.B.B.S.[2]

Synonyms and keywords:

Overview

The association between COVID-19 and headache was made in 2020. COVID-19 associated headache may be caused by the SARS-CoV-2 virus. There is no established system for the classification of COVID-19 associated headache. The exact pathogenesis of headache in COVID-19 patients is not fully understood. It is thought that headache is the result of cytokine release, direct invasion, metabolic disturbances, inflammation, dehydration, and hypoxia. COVID-19-associated headache must be differentiated from other diseases that cause headache, such as migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity. A positive history of fever and cough in addition to headache is suggestive of COVID-19-associated headache.

Historical Perspective

  • The association between COVID-19 and headache was made in December, 2019 during the SARS-CoV-2 outbreak initiated in Wuhan, Hubei Province, China.[1]

Classification

  • There is no established system for the classification of COVID-19 associated headache.

Pathophysiology

By Fahimeh Shojaei, M.D. / https://en.wikipedia.org/wiki/File:Migraine.jpg

Causes

Differentiating COVID-19-associated headache from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Incidence / Prevalence

  • WHO reported that more than 462,801 people have been infected worldwide, more than 380,723 of which are outside of China.[6]
  • The incidence/prevalence of COVID-19-associated headache is still unknown.
  • Guan et al. recently reported 13 percent of COVID-19-associated headache among 1099 laboratory-confirmed cases.

Age

  • There is insufficient information regarding age-specific prevalence or incidence of COVID-19-associated headache.

Gender

  • There is insufficient information regarding gender-specific prevalence or incidence of COVID-19-associated headache.

Race

  • There is insufficient information regarding race-specific prevalence or incidence of COVID-19-associated headache.

Risk Factors

  • There are no established risk factors for COVID-19-associated headache.

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19 associated headache.

Natural History, Complications, and Prognosis

Natural History

Complication

Diagnosis

Diagnostic Study of Choice

  • There are no established criteria for the diagnosis of COVID-19-associated headache.

History and Symptoms

  • The hallmark of COVID-19-associated headache is headache.
  • A positive history of fever and cough in addition to headache is suggestive of COVID-19-associated headache.

Common Symptoms

Less Common Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

  • There are no x-ray findings associated with COVID-19-associated headache.

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with COVID-19-associated headache.

MRI

  • There are no MRI findings associated with COVID-19-associated headache.

Other Imaging Findings

  • There are no other imaging findings associated with COVID-19-associated headache.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with COVID-19-associated headache.

Treatment

Medical Therapy

  • Medical therapy for COVID-assocaited-headache is still controversial.[7][8][9][10]
  • The use of NSAIDs, who received treatment early in the disease causes worsening of COVID-19 symptoms according to some anecdotal evidences.
  • In March 11, 2020, Fang et al. reported the hypothesis that ibuprofen (40 mg/kg/dose) can increase the risk of developing severe and fatal COVID-19 since ibuprofen is known to upregulate ACE2 receptors.
  • In March 23, 2020, US FDA announced that it is not aware of any evidence that NSAIDs such as ibuprofen could worsen COVID-19.
  • The European Medicines Agency and World Health Organization (WHO) have not yet recommended that NSAIDs be avoided.
  • Despite this recommendation, as a precautionary measure many providers are avoiding NSAIDs in patients with COVID-19.
  • In practice, the decision to continue or stop NSAIDs in patients with COVID-19 is made in collaboration between the treating physician and the patient, after a brief discussion on the limited available evidence.
  • More data are needed before broad recommendations are made.

Surgery

  • Surgical intervention is not recommended for the management of COVID-19-associated headache.

Primary Prevention

  • There are no established measures for the primary prevention of COVID-19 associated headache.

Secondary Prevention

References

  1. ↑ Meng X, Deng Y, Dai Z, Meng Z (June 2020). "COVID-19 and anosmia: A review based on up-to-date knowledge". Am J Otolaryngol. 41 (5): 102581. doi:10.1016/j.amjoto.2020.102581. PMC 7265845 Check |pmc= value (help). PMID 32563019 Check |pmid= value (help).
  2. ↑ Baig, Abdul Mannan; Khaleeq, Areeba; Ali, Usman; Syeda, Hira (2020). "Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms". ACS Chemical Neuroscience. 11 (7): 995–998. doi:10.1021/acschemneuro.0c00122. ISSN 1948-7193.
  3. ↑ St-Jean JR, Jacomy H, Desforges M, Vabret A, Freymuth F, Talbot PJ (August 2004). "Human respiratory coronavirus OC43: genetic stability and neuroinvasion". J. Virol. 78 (16): 8824–34. doi:10.1128/JVI.78.16.8824-8834.2004. PMC 479063. PMID 15280490.
  4. ↑ Rossi, Andrea (2008). "Imaging of Acute Disseminated Encephalomyelitis". Neuroimaging Clinics of North America. 18 (1): 149–161. doi:10.1016/j.nic.2007.12.007. ISSN 1052-5149.
  5. ↑ St-Jean, Julien R.; Jacomy, Hélène; Desforges, Marc; Vabret, Astrid; Freymuth, François; Talbot, Pierre J. (2004). "Human Respiratory Coronavirus OC43: Genetic Stability and Neuroinvasion". Journal of Virology. 78 (16): 8824–8834. doi:10.1128/JVI.78.16.8824-8834.2004. ISSN 0022-538X.
  6. ↑ Tu H, Tu S, Gao S, Shao A, Sheng J (2020). "Current epidemiological and clinical features of COVID-19; a global perspective from China". J Infect. 81 (1): 1–9. doi:10.1016/j.jinf.2020.04.011. PMC 7166041 Check |pmc= value (help). PMID 32315723 Check |pmid= value (help).
  7. ↑ Zhang J, Xie B, Hashimoto K (2020). "Current status of potential therapeutic candidates for the COVID-19 crisis". Brain Behav Immun. 87: 59–73. doi:10.1016/j.bbi.2020.04.046. PMC 7175848 Check |pmc= value (help). PMID 32334062 Check |pmid= value (help).
  8. ↑ MaassenVanDenBrink A, de Vries T, Danser A (April 2020). "Headache medication and the COVID-19 pandemic". J Headache Pain. 21 (1): 38. doi:10.1186/s10194-020-01106-5. PMC 7183387 Check |pmc= value (help). PMID 32334535 Check |pmid= value (help). Vancouver style error: initials (help)
  9. ↑ Fang L, Karakiulakis G, Roth M (2020) Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 8 (4):e21. DOI:10.1016/S2213-2600(20)30116-8 PMID: 32171062
  10. ↑ FitzGerald GA (2020) Misguided drug advice for COVID-19. Science 367 (6485):1434. DOI:10.1126/science.abb8034 PMID: 32198292


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