COVID-19: Could a headache be the only symptom?

The coronavirus is still a box of surprises, even for those who have had the disease and have recovered. Many know what this kind of ordeal is about that seems to never end after having COVID-19.

It is that one of the great problems that we have faced in the pandemic caused by SARS-CoV-2 is the multiple symptoms that the virus produces. There are several manifestations: from respiratory and cardiac difficulties, through loss of smell, fever, cough, to migraines and headaches that require clinical evaluation and continuity in medical studies to prevent chronic conditions.

After overcoming the infection phase, many patients continue to have multiple organs affected. Although there are many hypotheses and studies being carried out, the World Health Organization (WHO) assured that 1 in 10 people affected by the SARS-COV-2 virus continues to present symptoms up to 3 months after being diagnosed.

The mental problems caused by the coronavirus continue to add reports that alarm specialists. More and more successive comments from many convalescents of COVID-19 are being registered that indicate some dullness, mental slowness, memory loss, brain fog, confusion, or excessive effort to remember something.

Worldwide, more and more experts insist on paying attention to the symptoms of prolonged COVID and have focused on the consequences that this disease leaves in the individuals who suffered it, remembering that interdisciplinary treatments must be carried out to address the health problems that are perceived so that they are not aggravated and thus improve the quality of life.

Various studies have shown that the most common neurological symptom in COVID-19 patients is a headache. Some research also indicates that this could be the first and only symptom in some infections. This is suggested by a recent study published by the journal Neurology Asia whose main objective has been to determine the characteristics of the headache taking into account factors such as its frequency, duration, and location, as well as the relationship that could exist between the systemic inflammation caused by COVID-19 and headaches in patients infected by SARS-CoV -2.

The study included 202 patients hospitalized for COVID-19. Of these, 101 had headaches and 101 did not. Those responsible for the investigation evaluated the demographic characteristics, symptoms, medical history, and the results of various laboratory tests of all patients.

In the group reporting headaches, Visual Analogue Scale (VAS) scores were recorded, analyzing aspects such as duration, severity, and location of the pain. This scale has at one extreme the absence of pain and at the other, a pain registered at very high levels. When evaluating it, the patient marks a point on the said line to represent the degree of pain that he suffers.

As the research clarifies, 58.9% of the patients (119) did not have allusions to headaches prior to the infection in their medical records. 21.3% (43 patients) had a history of migraines. Most headache patients experienced short-term attacks of moderate severity (47.1), pressing (59%), and generalized (32.4%) in nature. For a better evaluation, the scientists divided the patients into two groups based on the severity of their headaches: a group consisting of patients with mild and/or moderate headaches, and another with those with severe headaches.

The comparisons evaluated between both groups allowed us to conclude that the duration of pain was greater in those with severe headaches. When the characteristics between the group with headaches and the group without headaches were compared, no significant differences were found between the groups in terms of inflammatory markers such as lymphocyte count, lactate dehydrogenase, C-reactive protein, ferritin, and dimer levels D.

“The headache in our COVID-19 patients was mostly new-onset, moderate in severity, compressive in nature, and generalized. Inflammatory markers were not related to the presence and severity of headaches, ”the study authors conclude.

Máximo Zimerman, medical director of the Cites Ineco center and specialist in Neurorehabilitation, that within the variety of residual symptoms within the neurological spectrum that he sees every day in his office, the most frequent are the disabling headache -present in 37 % of a series of 3,732 patients-, stroke, post-Covid-19 brain fog, seizures and movement disorders with instability, weakness, fatigue and muscle aches.

“We are seeing a wide spectrum of problems such as permanent headache, ageusia, syncope, astemia. 55% of hospitalized patients present some of these pathologies. And they can be a precursor to other more serious neuronal problems. But with COVID we are learning every day and using new tools to enhance rehabilitative treatments, ”explained Zimerman.

And I add: “In almost 40% of the patients we observe a strong post-covid headache that hinders normal daily functioning. And many times, related to the alteration of taste and smell and the recovery time is long. The patient feels sluggish, with trouble thinking. There are also behavioral disorders, anxiety, depression, apathy, indifference to things. In other patients, involuntary contractions are observed in all four limbs. And in them, we use medication to reverse this picture”.