Headaches and COVID-19 Infection: Epidemiology and Outcomes in a North African Sample

Rim KARRAY, Imen BEN SALEM, Mouna BOUAZIZ, Abdennour NASRI, Ahlem WALHA, Mariem MALLEK, Nour BELLAAJ, Mabrouk BAHLOUL, Olfa CHAKROUN-WALHA, Noureddine REKIK

Abstract

Objectives: This study aims to describe the epidemiological features of headaches in patients with
COVID-19 infection.
Methods: This is a cross-sectional study. Patients older than eighteen and diagnosed with a COVID-19
infection were included. We excluded patients aged less than eighteen, those whose headache could not
be assessed, those with a history of psychiatric or cognitive impairment, those who did not consent to
participate, and deceased patients.
Results: The study involved 728 patients, 371 had headaches due to the SARS-Cov2 infection. The
distribution of clinical forms of the COVID-19 infection in the entire population was as follows: 87.2%
asymptomatic or mild forms (n= 634), 8% moderate forms (n= 58), 4.8% severe forms (n=35).
Headaches were the second reported symptom, after anosmia (n= 400; 54%). Most patients reported a
headache in the first week of symptoms. The intensity of headaches was mild to moderate in 74.8% of
cases (n=275) and they improved within 5.7±4 days.
The univariate analysis showed an association between headaches and the following factors: female
gender (p<0.001), the clinical form of COVID-19 infection (p<0.001). Patients with a mild form had a
higher risk to develop COVID-19 infection-related headaches. Patients with comorbidities had also a
significantly higher risk to develop COVID-19-related headaches (p=0.012). The independent predictors
of acute COVID-19 infection-related headaches presence were only clinical forms of COVID-19
infection, fever, myalgia, abdominal pain, and sore throat (p<0.05).
Conclusion: Headaches associated with COVID-19 infection are frequent, with a female predominance.
They are generally moderate, holocranian paroxysmal, and pulsatile. Red flags are present in most cases