Persistent Headache After COVID-19: Clinical Patterns and Imaging Insights

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Duygu Arslan Mehdiyev, Gülgün Uncu, Pinar Uzun Uslu, Zeynep Özözen Ayas

Volume 9 · Issue 1 · pp. 159–162

Received: 20251128  Accepted: 20260206  Published: 20260317

Abstract

Introduction: This study examined the prevalence and clinical characteristics of persistent post-Coronavirus Disease 2019 (COVID-19) headache, and explored its associations with demographic, clinical, and neuroimaging parameters within a real-world patient cohort, thereby addressing a frequently reported yet insufficiently understood neurological complication.Materials and Methods: A total of 341 patients with polymerase chain reaction (PCR)-confirmed COVID-19 who presented with persistent symptoms to a neurology outpatient clinic were evaluated. Patients were grouped according to the presence or absence of an ongoing headache. Demographic characteristics, comorbidities, accompanying neurological and systemic symptoms, and neuroimaging findings (including conventional MRI, diffusion-weighted imaging, and MR venography when available) were compared between the groups. Statistical analyses included chi-squared tests, t-tests or non-parametric equivalents for group comparisons, and logistic regression models to identify independent associations between variables.Results: Persistent headache was reported by 36.9% of patients and was significantly more common among younger individuals and women (median age 45 vs. 55 years, p < 0.001; 42.9% vs. 27.5%, p = 0.004). Insomnia (p = 0.002), dizziness (p = 0.01), and myalgia/paresthesia (p = 0.03) were significantly more common in the headache group. In contrast, abnormal neuroimaging findings, including diffusion-weighted imaging (DWI) abnormalities and MR venography pathology, were significantly more frequent in patients without headaches. Among those with abnormal MRI findings, older age, comorbidity burden, and longer hospitalization duration were observed to be present. Multivariate analysis confirmed age and female sex as independent predictors of post-COVID headache.Conclusion:Post-COVID headache has a distinct clinical profile characterized by demographic susceptibility and concurrent dysautonomic or neuroinflammatory symptom clusters. These findings underline the need for focused clinical evaluation and improved understanding of the mechanisms underlying persistent headache during the post-infectious period.

Keywords: COVID-19; Post-Acute COVID-19 Syndrome; Headache; Nervous System Manifestations

References

  1. Fernández-de-las-Peñas C, Navarro-Santana M, Gómez-Mayordomo V, Cuadrado ML, García-Azorín D, Arendt-Nielsen L, et al. Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: a meta-analysis of the current literature. Eur J Neurol. 2021;28(11):3820-3825. Crossref
  2. Sampaio Rocha-Filho PA. Headache associated with COVID-19: Epidemiology, characteristics, pathophysiology, and management. Headache. 2022;62(6):650-656. Crossref
  3. Caronna E, Van Den Hoek TC, Bolay H, Garcia-Azorin D, Gago-Veiga AB, Valeriani M, et al. Headache attributed to SARS-CoV-2 infection, vaccination and the impact on primary headache disorders of the COVID-19 pandemic: a comprehensive review. Cephalalgia. 2023;43(1):03331024221131337. Crossref
  4. Excellence C. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NG188. London: National Institute for Health and Care Excellence; 2020.
  5. Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Cuadrado ML, Florencio LL. Defining post-COVID symptoms (post-acute COVID, long COVID, persistent post-COVID): an integrative classification. Int J Environ Res Public Health. 2021;18(5):2621. Crossref
  6. Garcia-Azorin D, Layos-Romero A, Porta-Etessam J, Membrilla JA, Caronna E, Gonzalez-Martinez A, et al. Post-COVID-19 persistent headache: a multicentric 9-months follow-up study of 905 patients. Cephalalgia. 2022;42(8):804-809. Crossref
  7. Porta-Etessam J, Matías-Guiu JA, González-García N, Gómez Iglesias P, Santos-Bueso E, Arriola-Villalobos P, et al. Spectrum of headaches associated with SARS-CoV-2 infection: study of healthcare professionals. Headache. 2020;60(8):1697-1704. Crossref
  8. Széphelyi K, Kóra S, Orsi G, Tollár J. Brain Structural Abnormalities in Patients with Post-COVID-19 Headache. Neurol Int. 2025;17(4):50. Crossref
  9. Tanashyan MM, Kuznetsova PI, Morozova SN, Annushkin VA, Raskurazhev AA. Neuroimaging correlates of post-COVID-19 symptoms: a functional MRI approach. Diagnostics (Basel). 2024;14(19):2180. Crossref
  10. Lee MH, Perl DP, Steiner J, Pasternack N, Li W, Maric D, et al. Neurovascular injury with complement activation and inflammation in COVID-19. Brain. 2022;145(7):2555-2568. Crossref
  11. Mohammadi S, Ghaderi S. Post-COVID-19 conditions: a systematic review on advanced magnetic resonance neuroimaging findings. Neurol Sci. 2024;45(5):1815-1833. Crossref
  12. Mohan N, Fayyaz MA, Del Rio C, Khurana NKRS, Vaidya SS, Salazar E, et al. Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):68. Crossref
  13. Ocak Ö, Şahin EM. Evaluation of Headache Characteristics in Patients Presenting with Suspected COVID-19. Ankara Med J. 2021;21(4):585-593. Crossref
  14. Liu JWTW, de Luca RDa, Mello HO, Barcellos I. Post-COVID-19 Syndrome? New daily persistent headache in the aftermath of COVID-19. Arq Neuropsiquiatr. 2020;78(11):753-754. Crossref
  15. Membrilla JA, Caronna E, Trigo-López J, González-Martínez A, Layos-Romero A, Pozo-Rosich P, et al. Persistent headache after COVID-19: Pathophysiology, clinic and treatment. Neurol Perspect. 2021;1(Suppl 1):S31-S36. Crossref
  16. Gomez-Dabo L, Melgarejo-Martinez L, Caronna E, Pozo-Rosich P. Headache in COVID-19 and long COVID: to know facts for clinical practice. Curr Neurol Neurosci Rep. 2023;23(10):551-560. Crossref
  17. Navis A, editor. A review of neurological symptoms in long COVID and clinical management. Semin Neurol. 2023;43(2):185-192. Crossref
  18. Rochmawati E, Iskandar AC, Kamilah F. Persistent symptoms among post-COVID-19 survivors: A systematic review and meta-analysis. J Clin Nurs. 2024;33(1):29-39. Crossref
  19. Taquet M, Sillett R, Zhu L, Mendel J, Camplisson I, Dercon Q, et al. Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients. Lancet Psychiatry. 2022;9(10):815-827. Crossref

Cite this article

Duygu Arslan Mehdiyev, Gülgün Uncu, Pinar Uzun Uslu, Zeynep Özözen Ayas. Persistent Headache After COVID-19: Clinical Patterns and Imaging Insights. Journal of Cukurova Anesthesia and Surgical Sciences. 9(1):159-162. https://doi.org/10.36516/jocass.1831148

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