Headaches could indicate a better clinical evolution of COVID-19, according to a study by the Vall d’Hebron Hospital in Barcelona

According to this research, published today in the journal ‘Cephalalgia’, local neuroinflammation near the nasal passages where the virus enters could be a defense system that would prevent the systemic cytokine storm associated with a severe COVID-19.

Headache, anosmia (loss of smell), and ageusia (loss of taste) are common neurological symptoms associated with coronavirus and the Vall d’Hebron doctors decided to look for an association between its appearance and the prognosis of COVID-19.

The study analyzed the symptoms and evolution of 130 patients with COVID-19 who arrived at the Vall d’Hebron Emergency Room for three weeks, between March and April.

All were seen by a neurologist due to the need to reorganize professionals in the face of the avalanche of patients during the first wave of COVID-19.

“That part of the patients were visited by doctors with different specialties allowed to carry out studies from different points of view, which provide information with symptoms that are not only respiratory”

said Patricia Pozo, head of the Headache and Neurological Pain group of the VHIR and neurologist at Hospital Vall d’Hebron.

Of these patients, 97 (74.6%) suffered from headaches, although only 19.6% had a history of episodic migraines prior to the disease.

In most, the headache was mild or moderate, but in a quarter of patients, mostly women and young people, it was more like a migraine.

In 21.4% of patients with persistent headache, this was a prodromal symptom, that is, it appeared before the other symptoms of the disease.

Looking at its evolution, patients who suffered from headaches when they arrived at the emergency room had a clinical duration of COVID approximately one week shorter: about 24 days in total in cases with headache, while, in patients without headache, the duration means illness was about 31 days.

“It seems clear that the presence of headache is a good prognostic factor for covid-19 and could serve to predict its evolution”

Pozo summarized.

The researchers also found an association between headache and anosmia and ageusia, since the loss of these senses was much more common in people with headaches.

Six weeks after arriving at the emergency room, they followed up the evolution of one hundred of the patients who had participated in the first phase of the study, including 74 who had headaches when they arrived at the hospital.

At the time of follow-up, 28 of these (37.8%) still had a headache with little response to treatment and it was often the only remaining symptom of COVID-19.

“These results demonstrate that headaches can persist after COVID-19 resolves , even in people with no previous history of migraines or recurrent headaches,” according to the researchers, who acknowledge that the study does not include very severe cases of the illness, which they could not interview, not very mild, because they did not go to the hospital.

Even so, Pozo defends “changing the concept that headache is an insignificant symptom in patients with covid-19 and its association must be studied in depth to understand the evolution of the disease and improve treatment.”

Researchers believe that SARS-CoV-2 infection could cause headache and one of the hypotheses is that the virus could mimic the onset of migraine, in which a strong inflammation of the trigeminovascular system is generated, which causes the pain.

“This local inflammation near the nostrils would serve as an initial defense system against the virus, which in people with headaches would be stronger and would avoid a cytokine storm,” according to Pozo.