Neurology Department, University Hospital "La Paz", Madrid, Spain.
La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
Headache. 2020 Nov;60(10):2176-2191. doi: 10.1111/head.13967. Epub 2020 Sep 28.
To describe the semiology of pain and its associated features in patients with coronavirus disease 2019 (COVID-19) and headache presenting to the emergency department who do not require urgent services.
Headache is one of the most frequent neurological symptoms reported in case series, epidemiological studies, and meta-analyses of COVID-19, with a prevalence ranging from 8 to 71.1%. Studies addressing the semiology of these headaches are lacking.
We conducted a cross-sectional study in the emergency department of a tertiary hospital. Patients classified according to the Manchester Triage System as standard and non-urgent and those fulfilling the criteria for probable or confirmed COVID-19 according to World Health Organization guidelines who presented with headache were included. A standardized questionnaire was used for data collection.
Of the 145 confirmed and probable COVID-19 patients, 99 (68.3%) reported headache. A total of 54/99 (54.5%) were classified with probable COVID-19 and 45/99 (45.5%) with confirmed COVID-19. The mean age (44.7 ± 11.8 vs 40.4 ± 10.7, P = .061), sex distribution (35/54 [64.8%] vs 28/45 [62.2%] female, P = .768), and headache comorbidity (19/54 [35.2%] vs 17/45 [37.8%], P = .789) were similar between the probable and confirmed COVID-19 groups, along with other medical comorbidities and laboratory data. Patients with confirmed COVID-19 showed a higher incidence of anosmia (21/54 [38.9%] vs 28/45 [62.2%], P = .021) and pneumonia (10/54 [18.5%] vs 18/45 [40%], P = .018), headache at onset (32/54 [59.3%] vs 39/45 [86.7%], P = .002), and hospital admission (0/54 [0%] vs 2/45 [11.1%], P = .017). In most cases, the headache appeared simultaneously with other COVID-19 symptoms (57/99, 57.6%). It was bilateral (86/99, 86.9%), frontal or holocranial (34/99, 34.3% each) in location and intense (60/99, 60.6%, reported a visual analog scale [VAS] score ≥7). A total of 39/99 (39.4%) identified triggers, most commonly fever. The most frequent aggravating factors were physical activity (45/99, 45.5%) and coughing (43/99, 43.4%). Patients showed a propensity toward prostration (41/99, 41.4%), photophobia (29/99, 29.3%), and phonophobia (27/99, 27.3%). Partial (53/99, 53.5%) or total (26/99, 26.3%) responses to first-step analgesics were reported. A total of 25/99 (25.3%) patients had a prior history of migraine, presenting with headache different from the usual in 23/25 (92.0%) patients. Individuals with migraine were more likely to have earlier (headache at onset of the respiratory symptoms in 24/25 [96.0%] vs 57/74 [77.0%], P = .023 [95% CI: 0.067, 0.313]), longer (>24 hours of pain in 20/25 [80%] vs 25/74 [33.8%], P < .001 [95% CI: 0.272, 0.652]), and more intense (VAS score ≥5 in 25/25 [100%] vs 63/74 [85.1%], P = .043 [95% CI: 0.057, 0.213]) headaches than patients without migraine.
Headache is a very prevalent COVID-19 symptom among patients presenting to the emergency room, most frequently presenting as holocranial or bifrontal moderate to severe, and pressing quality headache. Individuals with migraine tend to present with earlier, longer, and more intense headaches.
描述 2019 冠状病毒病（COVID-19）患者出现头痛并到急诊科就诊但无需紧急服务时疼痛的症状及其相关特征，这些患者出现头痛的同时伴有 COVID-19。
头痛是病例系列、流行病学研究和 COVID-19 荟萃分析中报告的最常见神经系统症状之一，其发病率为 8%至 71.1%。目前缺乏针对这些头痛症状的研究。
我们在一家三级医院的急诊科进行了一项横断面研究。纳入标准为根据世界卫生组织（WHO）指南分类为标准和非紧急患者，以及符合可能或确诊 COVID-19 标准且出现头痛的患者。使用标准化问卷收集数据。
在 145 例确诊和可能的 COVID-19 患者中，99 例（68.3%）报告有头痛。其中 54 例（54.5%）被归类为可能 COVID-19，45 例（45.5%）为确诊 COVID-19。两组患者的平均年龄（44.7±11.8 岁 vs 40.4±10.7 岁，P=0.061）、性别分布（35/54[64.8%] vs 28/45[62.2%]女性，P=0.768）和头痛合并症（19/54[35.2%] vs 17/45[37.8%]，P=0.789）相似，其他合并症和实验室数据也相似。确诊 COVID-19 患者的嗅觉丧失（21/54[38.9%] vs 28/45[62.2%]，P=0.021）和肺炎（10/54[18.5%] vs 18/45[40%]，P=0.018）的发生率更高，头痛发作（32/54[59.3%] vs 39/45[86.7%]，P=0.002）和住院（0/54[0%] vs 2/45[11.1%]，P=0.017）的比例更高。在大多数情况下，头痛与其他 COVID-19 症状同时出现（57/99，57.6%）。头痛部位为双侧（86/99，86.9%）或全颅（34/99，各占 34.3%），程度剧烈（60/99，60.6%，视觉模拟评分[VAS]≥7）。99 例患者中有 39 例（39.4%）确定了触发因素，最常见的是发热。最常见的加重因素是体力活动（45/99，45.5%）和咳嗽（43/99，43.4%）。患者表现出易疲劳（41/99，41.4%）、畏光（29/99，29.3%）和畏声（27/99，27.3%）。首次镇痛治疗的部分（53/99，53.5%）或完全（26/99，26.3%）缓解率报告。99 例患者中有 25 例（25.3%）有偏头痛病史，与以往偏头痛发作不同的头痛有 23 例（92.0%）。偏头痛患者的头痛更早（呼吸道症状发作时头痛的发作时间为 24/25[96.0%] vs 57/74[77.0%]，P=0.023[95%CI：0.067，0.313]），持续时间更长（疼痛超过 24 小时的为 20/25[80%] vs 25/74[33.8%]，P<0.001[95%CI：0.272，0.652]），程度更剧烈（VAS 评分≥5 的为 25/25[100%] vs 63/74[85.1%]，P=0.043[95%CI：0.057，0.213]）。
头痛是急诊科 COVID-19 患者非常常见的症状，最常表现为全颅或双额部中度至重度、紧压性头痛。偏头痛患者的头痛通常更早、持续时间更长、程度更剧烈。
