Headache may be one of the earliest symptoms of coronavirus disease (COVID)-19, and identifying patients with the characteristic features may help to provide early isolation and treatment, according to study results published in Headache.

While headache is a common complaint among patients hospitalized with COVID-19, limited data are available on headache features in this population. Study researchers sought to assess the clinical characteristics of headache related to the disease.

This was an observational study that included patients who were referred to a headache unit due to headache and had laboratory-confirmed COVID-19 illness between April 15 and May 15, 2020. In total, there were 13 (mean age, 40.2 years; 9 women) patients with mild COVID-19 and a chief complaint of headache.

Of the 13 patients, 7 had no prior history of headaches, 5 were diagnosed with migraine, and 1 had rare tension-type headache attacks. All participants reported that the headaches had different features from previous attacks and/or were distressful. In most cases, headaches were described as moderate to severe intensity and incapacitating.

The headaches had migraine-like features, including throbbing and/or pressing nature in almost all patients, aggravation with routine movements and bending over, sensory disturbances such as photophobia and/or phonophobia, nausea, and recovery within several days.

However, the headaches also had some unusual features, including new unrelenting pain, rapid onset, higher intensity, and association with anosmia/ageusia, diarrhea, reduced appetite, and weight loss. Study researchers observed a partial response or temporary recovery lasting hours following use of analgesics, mainly paracetamol or nonsteroidal anti-inflammatory drugs.

Previously, it was suggested that headache may be more common in patients with gastrointestinal symptoms. In this cases series, gastrointestinal symptoms, including diarrhea, loss of appetite, or weight loss, were reported in 5 of the 13 patients. In some patients with headache, there was a 5 kg weight loss within 3 days; study researchers suggested that the rapid weight loss with reduced appetite are potential distinctive features of COVID-19 headache.

“Headache is one of the earliest symptoms of the COVID-19 and could be an isolated feature of the illness,” the study researchers concluded. They added that headaches associated with the disease displayed “features resembling migraine and/or atypical symptoms including anosmia and diarrhea.”

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