PDF(Pubmed)
Abstract：
BACKGROUND: Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes.
METHODS: We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants\' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student\'s t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson\'s chi-square and Fisher\'s exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH.
RESULTS: Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH.
CONCLUSIONS: This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
METHODS: We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants\' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student\'s t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson\'s chi-square and Fisher\'s exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH.
RESULTS: Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH.
CONCLUSIONS: This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
摘要：
背景：持续性头痛是2019年冠状病毒病（COVID-19）后的常见症状，目前对其临床谱和诱发因素的了解有限。部分患者可能在COVID-19后出现新的每日持续性头痛（NDPH），这是治疗中最难治性的原发性头痛综合征之一。
方法：我们在拉丁美洲进行了一项横断面研究，以表征严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）感染后持续头痛的个体，并确定与NDPH相关的因素。18岁以上的SARS-CoV-2感染检测呈阳性并报告其症状中持续头痛的参与者完成了一项在线调查，其中包括人口统计学，既往病史,持续性头痛的临床特征，和COVID-19疫苗接种状况。根据参与者的回答，使用NDPH诊断标准将参与者分为NDPH组和非NDPH组。参与者数据通过描述性统计进行总结。根据定量变量的分布使用学生t和Mann-WhitneyU检验。对于分类变量，根据预期频率的大小使用Pearson的卡方检验和Fisher的精确检验。使用后向逐步选择方法进行二项逻辑回归以识别与NDPH相关的因素。
结果：来自11个拉丁美洲国家的四百二十一名参与者符合纳入标准。四分之一的参与者符合NDPH诊断标准。平均年龄是40岁,大多数参与者是女性（82%）。超过90%的参与者报告患有轻度/中度COVID-19。大多数参与者在发展为COVID-19之前有头痛史（58%），主要为偏头痛型（32%）。NDPH组最主要的临床特征是枕骨位置，严重/难以忍受的强度，燃烧的性格，和放射痛（p<0.05）。焦虑症状的比例更高，睡眠问题,肌痛，精神迷雾,感觉异常,恶心,面部或额头出汗，据报道,NDPH患者的伴随症状为迟钝或低尿(p<0.05).在COVID-19急性期，枕骨位置，眼睑水肿是伴随症状，头痛的烧灼性是与NDPH相关的危险因素。
结论：这是拉丁美洲首次研究SARS-CoV-2感染后NDPH的临床谱及其相关因素。对持续头痛的COVID-19患者的临床评估应考虑NDPH。
方法：我们在拉丁美洲进行了一项横断面研究，以表征严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）感染后持续头痛的个体，并确定与NDPH相关的因素。18岁以上的SARS-CoV-2感染检测呈阳性并报告其症状中持续头痛的参与者完成了一项在线调查，其中包括人口统计学，既往病史,持续性头痛的临床特征，和COVID-19疫苗接种状况。根据参与者的回答，使用NDPH诊断标准将参与者分为NDPH组和非NDPH组。参与者数据通过描述性统计进行总结。根据定量变量的分布使用学生t和Mann-WhitneyU检验。对于分类变量，根据预期频率的大小使用Pearson的卡方检验和Fisher的精确检验。使用后向逐步选择方法进行二项逻辑回归以识别与NDPH相关的因素。
结果：来自11个拉丁美洲国家的四百二十一名参与者符合纳入标准。四分之一的参与者符合NDPH诊断标准。平均年龄是40岁,大多数参与者是女性（82%）。超过90%的参与者报告患有轻度/中度COVID-19。大多数参与者在发展为COVID-19之前有头痛史（58%），主要为偏头痛型（32%）。NDPH组最主要的临床特征是枕骨位置，严重/难以忍受的强度，燃烧的性格，和放射痛（p<0.05）。焦虑症状的比例更高，睡眠问题,肌痛，精神迷雾,感觉异常,恶心,面部或额头出汗，据报道,NDPH患者的伴随症状为迟钝或低尿(p<0.05).在COVID-19急性期，枕骨位置，眼睑水肿是伴随症状，头痛的烧灼性是与NDPH相关的危险因素。
结论：这是拉丁美洲首次研究SARS-CoV-2感染后NDPH的临床谱及其相关因素。对持续头痛的COVID-19患者的临床评估应考虑NDPH。
