Headache Medicine 2020, 11(4):79-80 ISSN 2178-7468, e-ISSN 2763-6178
79
ASAA
DOI: 10.48208/HeadacheMed.2020.23
Headache Medicine
© Copyright 2020
Editorial
Long Covid and persistent headache
Marcelo Moraes Valença
1
, Juliana Ramos de Andrade
1
, Mario Fernando Prieto Peres
2
1
Federal University of Pernambuco, Recife, Pernambuco, Brazil
2
IPq – HCFMUSP, São Paulo, São Paulo, Brazil
We are going through this moment with so many cases of patients with Covid-19, and the high mortal-
ity rate is very worrying. For patients recovering from the acute phase of viral infection, a signicant
number of sequelae can remain for a long time, probably some of these sequelae have a permanent
character; we will only know about this over time.
1,2
Neurological alterations are frequent in Covid-19, such as cognitive complaints, headache, smell and
taste dysfunctions, among others.
2-12
With a certain frequency, patients with rare migraine episodes or even those who never report
any migraine or tension-type headache attacks are arriving in our ofces with daily or almost daily
headaches after being affected by Covid-19.
4,13-17
This clinical picture of pain can persist for weeks
or months, associated or not with other symptoms such as tiredness, inability to perform trivial tasks,
discouragement, depression and aggressively. In addition, a decit in the cognitive sphere is also a
frequent problem in these patients.
3,18,19
Thus, this clinical condition has been termed as “chronic Covid
syndrome”, “Long Covid”, or "Covid long-haulers."
15,20 -24
In general, what has been considered for the diagnosis of long Covid is the persistence or appearance
of symptoms, not explained by any other cause
25,28
, days after SARS-CoV-2 infection.
20
There is a spectrum of severity observed in patients with Covid-19, from a complete absence of symptoms
to severe deterioration of various physiological parameters, such as renal, cardiac, hematological,
immunologic, nutritional, pulmonary or hepatic functions; in short, any organ can be affected during
the viral infection. These critically ill patients need to receive ventilatory support with sedation in an
intensive care unit, thus undergoing several invasive interventions to save their life.
26-29
Recovery from
this intense physio-emotional strain is very laborious for those who have survived and require many
months of rehabilitation.
30
In this way, there are several possible causes of Long Covid, such as exhaustion of the organism against
the virus, immunological, action of drugs, high level of stress, sleep deprivation, among others not yet
understood. This group of patients needs to be better studied to prevent the onset of Long Covid or the
headache associated with it. And we still know little about the best way to treat the headache attacks
of these patients with Long Covid.
Marcelo Moraes Valença
mmvalenca@yahoo.com.br
Received: September 15, 2020
Accepted: November 19, 2020
80
ASAA
Valença MM, Andrade JR, Peres MFP
Long Covid and persistent headache
Marcelo Moraes Valença
https://orcid.org/0000-0003-0678-3782
Juliana Ramos Andrade
https://orcid.org/0000-0002-5445-8872
Mario Fernando Prieto Peres
https://orcid.org/0000-0002-0068-1905
References
1. Valença MM, Fonseca MMRFF, Branco CA, et al. Unimed
Recife's experience in treating 1,039 patients with Covid-19.
Avanços em Medicina
2021;1:12-17
2. Heneka MT, Golenbock D, Latz E, et al. Immediate and long-
term consequences of COVID-19 infections for the development
of neurological disease.
Alzheimers Res Ther
2020;12:69
3. Liu J, de Luca RD, Mello Neto HO, et al. Post-COVID-19 Syn-
drome? New daily persistent headache in the aftermath of
COVID -19.
Arq Neuropsiquiatr
2020;78:753-754
4. Magdy R, Hussein M, Ragaie C, et al. Characteristics of
headache attributed to COVID-19 infection and predictors of
its frequency and intensity: A cross sectional study.
Cephalalgia
2020;40:1422-1431
5. Peng KP. Association between COVID-19 and headache: What
evidence and history tell us.
Cephalalgia
2020;40:1403-1405
6. Rocha-Filho PAS, Magalhaes JE. Headache associated with
COVID-19: Frequency, characteristics and association with
anosmia and ageusia.
Cephalalgia
2020;40:1443-1451
7. Singh J, Ali A. Headache as the Presenting Symptom in 2
Patients With COVID-19 and a History of Migraine: 2 Case
Reports.
Headache
2020;60:1773-1776
8. Toptan T, Aktan C, Basari A, et al. Case Series of Headache
Characteristics in COVID-19: Headache Can Be an Isolated
Symptom.
Headache
2020;60:1788-1792
9. Trigo J, Garcia-Azorin D, Planchuelo-Gomez A, et al. Factors
associated with the presence of headache in hospitalized
COVID-19 patients and impact on prognosis: a retrospective
cohort study.
J Headache Pain
2020;21:94
10. Uygun O, Ertas M, Ekizoglu E, et al. Headache characteris-
tics in COVID-19 pandemic-a survey study.
J Headache Pain
2020;21:121
11. Wells RE, Strauss LD. The Value of Headache-Specic Recom-
mendations During COVID-19.
Headache
2020;60:820-823
12. Aragao M, Leal MC, Cartaxo Filho OQ, et al. Anosmia in
COVID-19 Associated with Injury to the Olfactory Bulbs Evident
on MRI.
AJNR Am J Neuroradiol
2020;41:1703-1706
13. Long COVID: let patients help define long-lasting COVID
symptoms.
Nature
2020;586:170
14. Managing long covid: don't overlook olfactory dysfunction.
BMJ
2020;370:m3771
15. Baig AM. Deleterious Outcomes in Long-Hauler COVID-19: The
Effects of SARS-CoV-2 on the CNS in Chronic COVID Syndrome.
ACS Chem Neurosci
2020;11:4017-4020
16. Martelletti P, Bentivegna E, Luciani M, et al. Headache as a
Prognostic Factor for COVID-19. Time to Re-evaluate.
SN Compr
Clin Med
2020:1-2
17. Sampaio Rocha-Filho PA, Voss L. Persistent Headache and
Persistent Anosmia Associated With COVID-19.
Headache
2020;60:1797-1799
18. Dasgupta A, Kalhan A, Kalra S. Long term complications
and rehabilitation of COVID-19 patients.
J Pak Med Assoc
2020;70(Suppl 3):S131-S135
19. Doykov I, Hallqvist J, Gilmour KC, et al. 'The long tail of
Covid-19' - The detection of a prolonged inammatory re-
sponse after a SARS-CoV-2 infection in asymptomatic and mildly
affected patients.
F1000Res
2020;9:1349
20. Mendelson M, Nel J, Blumberg L, et al. Long-COVID: An evolv-
ing problem with an extensive impact.
S Afr Med J
202 0;111:10 -
12
21. Greenhalgh T, Knight M. Long COVID: A Primer for Family
Physicians.
Am Fam Physician
2020;102:716-717
22. Halpin S, O'Connor R, Sivan M. Long COVID and chronic
COVID syndromes.
J Med Virol
2021;93:1242-1243
23. Nabavi N. Long covid: How to dene it and how to manage
it.
BMJ
2020;370:m3489
24. Nath A. Long-Haul COVID. Neurology 2020;95:559-560
25. Abdallah H, Portereld F, Fajgenbaum D. Symptomatic relapse
and long-term sequelae of COVID-19 in a previously healthy
30-year-old man.
BMJ Case Rep
2020;13
26. Hassenpug MS, Jun D, Nelson DR, et al. Post-COVID recovery:
characteristics of chronically critically ill patients admitted to a
long-term acute care hospital.
F1000Res
2020;9:1241
27. Heudorf U, Muller M, Schmehl C, et al. COVID-19 in long-
term care facilities in Frankfurt am Main, Germany: incidence,
case reports, and lessons learned.
GMS Hyg Infect Control
2020;15:Doc26
28. Higgins V, Sohaei D, Diamandis EP, et al. COVID-19: from an
acute to chronic disease? Potential long-term health consequenc-
es.
Crit Rev Clin Lab Sci
2020:1-23
29. Mandal S, Barnett J, Brill SE, et al. 'Long-COVID': a cross-sec-
tional study of persisting symptoms, biomarker and imaging
abnormalities following hospitalisation for COVID-19.
Thorax
2020
30. Petersen MS, Kristiansen MF, Hanusson KD, et al. Long COVID
in the Faroe Islands - a longitudinal study among non-hospital-
ized patients.
Clin Infect Dis
2020
