Months After COVID-19, Report Describes Case of the Constant Headache

A recent case report describes a female patient with coronavirus disease 2019 (COVID-19) who, at the time of publication, has had a headache for 85 straight days, starting shortly after she first became sick.

Numerous reports have described how some patients who have had COVID-19 suffer for months with a variety of ailments.

The researchers in this case said not much is known about COVID-19-related headaches and that respiratory symptoms are the more typical ones related to the disease.

In this instance, the patient, a 40-year-old female, had a previous diagnosis of migraine with and without aura. In the 30 days prior to being diagnosed with COVID-19, she had only 3 days marred by headaches.

For this patient, the first symptom of the virus was diarrhea, followed by fatigue, dry cough, and muscle pain that began on the second day; the symptoms lasted for 5 days. On the fourth day, she lost her sense of smell, and also had facial pain which lasted for 48 hours. Her nasal swab reverse transcription polymerase chain reaction COVID-19 test was positive.

The headaches set in on the fifth day; they were described as a bilateral frontotemporal, pulsating headache that was aggravated with mild physical activity. She was also sensitive or averse to light and sound. She described her headache pain as continuous and severe for 7 days and even as other symptoms eased, the intensity of her headache worsened.

She also recorded the frequency of the headaches during the 2 months following the symptomatic phase of the virus, and had a headache 3 days or more during all of the weeks, including suffering a headache 6 out of 7 days for 2 weeks straight.

At the time of publication of the report, the current headache lasts for 6 hours and is moderate to severe; she has been using naproxen and sumatriptan for pain relief. With these headaches, she never had aura and she did not consider these headaches like her migraines. Out of all of her virus symptoms, her headaches were considered the worst of symptoms.

At the time of publication, she had not regained her sense of smell.

While various tests were normal, such as her MRI, the authors noted that it was performed 23 days after she lost her sense of smell. Some patients with COVID-19 who have had MRIs have shown changes in the olfaction‐related structures; the researchers said it may be likely that SARS-CoV-2 enters through the nose and that continued "anosmia reinforces the possibility of an injury to the olfactory pathway."

In addition, the researchers said they could not rule out that she had viral meningitis due to the lack of a lumbar puncture. In ruling out other causes, thee also said it is possible that the new headache was a worsening of her previous headache; theyalso noted that stress can trigger migraines and that viral diseases can worsen primary headaches.

The authors also did not think it is likely that her headache was the result of overuse of medication. Despite the use of pain medications, her headaches improved over time, and her headache had already begun as a continuous headache.

Reference

Sampaio Rocha-Filho PA, Voss L. Persistent headache and persistent anosmia associated with COVID‐19. Headache. Published online August 13, 2020. doi: 10.1111/head.13941