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Abstract Details

Headache as the Presenting Symptom of COVID-19 in Two Patients with a History of Migraine
Headache Posters (7:00 AM-5:00 PM)
Coronavirus disease 2019 (COVID-19), which emerged in December, 2019, is now a global pandemic. While the most common symptoms of COVID-19 are fever, cough, and shortness of breath, neurological symptoms including headache have been reported in up to 13% of patients.  The mechanism by which COVID-19 causes headache remains unclear. One may postulate that its mechanism is like other respiratory viruses such as influenza A and B, in which headache often accompanies fever and fatigue. 

To highlight headache as a possible presenting symptom of COVID-19.

We report the case of 2 young females aged 31 and 32 with a history of episodic and chronic migraine respectively, who developed intractable daily headache as their first symptom of COVID-19. The headache was distinct from their usual migraine and occurred daily 1 week prior to developing typical COVID-19 symptoms. Both patients tested positive for COVID-19 via nasopharyngeal swab PCR.
The first patient’s headache and typical COVID symptoms resolved in 4 days with conservative measures. The second patient’s headache resolved 2 days after switching her headache regimen following a telehealth visit 2 weeks after the onset of the headache. Topiramate was increased to 100mg, sumatriptan was switched to rizatriptan, and she was started on tizanidine 4mg q8h prn.

This is, to our knowledge, the first reports of headache as an initial presenting symptom of COVID-19. The above two cases demonstrate that patients with a history migraine may experience headache as their first symptom, and due to severe headache, may be more disabled by the infection compared with age-matched cohorts. Until we have more data, healthcare providers caring for these patients should prepare treatment plans to optimally manage headache during COVID-19 infection. Further studies are needed to better understand the implications of headache in COVID-19 patients.

Jyotika Singh (Henry Ford Health System)
Ms. Singh has nothing to disclose.
Ashhar Ali, DO, FAAN (Henry Ford) Dr. Ali has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Ali has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Ebsco.