Headaches During COVID-19: My Clinical Case and Review of the Literature
Headaches During COVID-19: My Clinical Case and Review of the Literature
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DOI：
10.1111/head.13841
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发表时间：
2020-05-15
期刊：
影响因子：
5
通讯作者：
Belvis, Robert
中科院分区：
文献类型：
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作者：
Belvis, Robert
目的分析2019冠状病毒病（COVID-19，简称COVID-19）引起的头痛的临床特征，为临床治疗提供依据。第一例报告病例于2019年12月1日发生在武汉。目前，全球至少有180万人感染，近11万人死亡。许多研究已经分析了COVID-19的临床表现，但它们主要集中在呼吸系统症状和头痛的一般治疗。方法我描述并讨论了我在COVID-19期间的头痛，并回顾了MEDLINE关于头痛和COVID-19的文献。然而，在这些研究中没有进行头痛表征。作为一名头痛专家，根据我个人的临床病例，与COVID-19相关的头痛可以分为两个阶段。全身性病毒感染引起的急性头痛、原发性咳嗽头痛、紧张型头痛和隐斜视引起的头痛可出现在第一阶段（流感样阶段）;如果出现第二阶段（细胞因子风暴阶段），则可出现缺氧引起的头痛和难以纳入ICHD 3的新头痛。所有这些都是ICHD 3中规定的头痛，除了1例发生在临床发作后第7天。这种头痛可能与一些患者遭受的细胞因子风暴有关，并且可以将其归类于由其他非感染性炎症性颅内疾病引起的头痛的ICHD 3头痛。尽管报告的头痛作为COVID-19感染症状的患病率很低，但这一经验表明，它很可能被低估了。
Objective To analyze headaches related to COVID-19 based on personal case experience.Background COVID-19 is an infection caused by the new coronavirus SARS-CoV-2. The first reported case happened in Wuhan on December 1, 2019. At present, at least 1.8 million people are infected around the world and almost 110,000 people have died. Many studies have analyzed the clinical picture of COVID-19, but they are focused on respiratory symptoms and headache is generically treated.Methods I describe and discuss my headaches during my COVID-19 and I review the MEDLINE literature about headaches and COVID-19.Results More than 41,000 COVID-19 patients have been included in clinical studies and headache was present in 8%-12% of them. However, no headache characterization was made in these studies. As a headache expert and based on my own personal clinical case, headaches related to COVID-19 can be classified in the 2 phases of the disease. Acute headache attributed to systemic viral infection, primary cough headache, tension-type headache and headache attributed to heterophoria can appear in the first phase (the influenza-like phase); and headache attributed to hypoxia and a new headache, difficult to fit into the ICHD3, can appear if the second phase (the cytokine storm phase) occurs.Conclusions Several headaches can appear during COVID-19 infection. All of them are headaches specified in the ICHD3, except 1 that occurs from the 7th day after the clinical onset. This headache is probably related to the cytokine storm that some patients suffer and it could be framed under the ICHD3 headache of Headache attributed to other non-infectious inflammatory intracranial disease. Although the reported prevalence of headaches as a symptom of COVID-19 infection is low, this experience shows that, very probably, it is underestimated.