Headache as a COVID-19 onset symptom or Post-COVID symptom according to the SARS-CoV-2 Variant

ABSTRACT

Introduction

COVID19 associated headaches are highly common and there is currently an unmet need to better understand their association with SARSCoV2 variants. Headaches are a prevalent symptom in the acute phase of COVID19 and are associated with a better prognosis and better immune response. They are also a relevant post-COVID symptom.

Areas covered

This article analyses the differences in the prevalence of headache as an onset symptom and in post-COVID headache among the different SARS-CoV-2 variants: the historical strain, Alpha, Delta and Omicron. The different pathophysiological mechanisms by which SARS-CoV-2 infection may cause headache are also discussed.

Expert opinion

The presence of headache at the acute phase is a risk factor for post-COVID headache, whereas a history of primary headache does not appear to be associated with post-COVID headache. The prevalence of headache as an onset symptom appears to be variable for the different SARS-CoV-2 variants, but current data are inconclusive. However, the current evidence also suggests that headache represents a prevalent symptom in the acute and post-infection COVID-19 phase, regardless of SARS-CoV-2 variant.

KEYWORDS:

• Headache
• COVID-19
• post-COVID
• long COVID
• SARS-CoV-2
• variant

Article highlights

• Headache is a common onset symptom in the acute phase of COVID-19.

• Headache as an onset symptom of COVID-19 is associated with a better prognosis and a more efficient immune response.

• The prevalence of headache as an onset symptom seems to be variable for the different SARS-CoV-2 variants.

• Headache is also a frequent and disabling persistent post-COVID symptom.

• A previous history of primary headache is not a risk factor for the development of de novo post-COVID headache.

• The occurrence of headache as an onset symptom in the acute phase of infection is a risk factor for the development of post-COVID headache.

• The mechanisms explaining the development of COVID-19-associated headache appear to be similar among the different SARS-CoV-2 variants.

Acknowledgments

The Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121) and Novo Nordisk Foundation (NNF21OC0067235).

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.