Division of Headache, Department of Neurology, Stanford School of Medicine, Palo Alto, California, USA.
Division of Comprehensive Neurology, Department of Neurology, Stanford School of Medicine, Palo Alto, California, USA.
Headache. 2022 Jul;62(7):903-907. doi: 10.1111/head.14337. Epub 2022 Jun 7.
Headache can be a prominent feature of Post-Acute Sequelae of SARS-Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection.
We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID-19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis.
Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD-3) criteria for migraine, with 20/31 (65%) meeting ICHD-3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full-time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches.
Our study presents a group of patients with protracted headache after COVID-19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD-3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.
头痛是 SARS-CoV2 感染后急性后遗症（PASC）的一个突出特征，先前的研究集中在感染后一个月内已解决的 PASC 头痛。
我们对 2020 年 9 月至 2022 年 1 月期间在斯坦福头痛诊所接受评估的 31 名成年人进行了回顾性图表审查，这些成年人在 COVID-19 感染后出现新发或加重的头痛，且在评估时仍未解决，评估内容包括人口统计学、病史和头痛诊断。
头痛在感染后平均持续 7.4±4.8 个月。值得注意的是，31 例中有 25 例（81%）有先前的头痛史。头痛的具体特征差异很大，但 23 例（74%）符合国际头痛疾病分类，第三版（ICHD-3）偏头痛标准，其中 20 例（65%）符合 ICHD-3 慢性偏头痛标准，而仅有 5 例（16%）在 COVID 感染前符合这些标准。此外，全职工作从 31 例中的 25 例（81%）下降到 17 例（55%）。在我们诊所接受治疗之前，18 例患者中有 13 例（72%）开始使用目前用于偏头痛管理的预防性药物，报告头痛的频率和/或严重程度降低。
我们的研究提出了一组 COVID-19 感染后持续性头痛的患者，包括头痛负担较低的患者，这些患者主要表现为从阵发性到慢性偏头痛的慢性化，以及无先前头痛史的患者，他们符合 ICHD-3 头痛标准，归因于系统性病毒疾病，主要表现为偏头痛样表型。
