Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution.
Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution.
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DOI：
10.1177/0333102420965157
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Pozo-Rosich P
中科院分区：
文献类型：
--
作者：
Caronna E;Ballvé A;Llauradó A;Gallardo VJ;Ariton DM;Lallana S;López Maza S;Olivé Gadea M;Quibus L;Restrepo JL;Rodrigo-Gisbert M;Vilaseca A;Hernandez Gonzalez M;Martinez Gallo M;Alpuente A;Torres-Ferrus M;Pujol Borrell R;Alvarez-Sabin J;Pozo-Rosich P
明确头痛的特征和演变与COVID-19及其炎症反应的关系。这是一项前瞻性研究，比较了在急诊室招募的有头痛和无头痛的COVID-19患者的临床数据和炎症生物标志物。我们将基线与6周随访进行比较，以评估疾病进展。130例患者中74.6%（97/130）有头痛。总的来说，24.7%（24/97）的患者有重度疼痛伴偏头痛样特征。头痛患者的嗅觉丧失/味觉丧失更多（54.6% vs. 18.2%; p < 0.0001）。头痛组的COVID-19临床持续时间较短（23.9 ± 11.6 vs. 31.2 ± 12.0天; p = 0.028）。在头痛组中，ER时IL-6水平较低（22.9（57.5）vs. 57.0（78.6）pg/mL; p = 0.036），住院期间更稳定。6周后，在74例随访的头痛患者中，37.8%（28/74）的患者持续头痛。其中50%（14/28）无头痛病史。头痛是21.4%（6/28）持续头痛患者的COVID-19前驱症状（p = 0.010）。与COVID-19相关的头痛是一种常见症状，预示着COVID-19临床病程较短。在COVID-19解决后，致残性头痛可能持续存在。在病理生理学上，其偏头痛样特征可能反映了炎症或SARS-CoV-2直接参与的三叉神经血管系统激活，这一假设得到了伴随嗅觉丧失的支持。
To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.
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