COVID 19-Associated headache: Critical review after a scientific webinar

Coronavirus disease 2019 (COVID-19)-related headache is the fifth most frequent symptom and the most common neurologic manifestation of the disease with a prevalence of 6.5%–27.9%. Headache related to COVID-19 shows diverse features and can clinically manifest with different phenotypes. The most common clinical presentation is bilateral (mostly frontal or frontotemporal location), long-lasting, pressing/pulsating quality, and partially or completely resistant to analgesic treatment. The activation of the trigeminovascular system by either direct invasion of the virus or indirect mechanisms induced by cytokine storm, excess neuroinflammation, vasculopathy, and ischemia are the possible underlying pathophysiologic mechanisms. Patients with preexisting primary headaches is another important issue that needs to be enlightened to determine whether these patients are more susceptible to COVID-19-related headache. Headache is also an important symptom in patients with long COVID syndrome, which has a serious negative impact on the individuals' quality of life in the long term. Populations such as children, pregnant women, and the elderly are more vulnerable to COVID-19, and it is obvious that COVID-19 affects these populations differently. The headache characteristics and course of headache in these special populations is an important research topic that needs more focused studies. In this review, we attempted to update physicians with the new developments about COVID-19-related headaches and discuss the subject with different aspects in light of the recent “COVID-19-associated headache webinar” organized by the Global Migraine and Pain society (GMPS) in collaboration with the global COVID-19 Neuro Research Coalition and the European Academy of Neurology (EAN).