Incidence of First Migraine After COVID-19 Infection in Male Adults
Based on the available evidence, approximately 26.4% of adults develop de novo headaches, including migraines, following COVID-19 infection, with male patients experiencing more severe headache symptoms compared to females. 1
Epidemiology of Post-COVID Headaches
- De novo headaches (headaches occurring for the first time) develop in 26.4% of adults following COVID-19 infection 1
- Male patients tend to experience more severe headache symptoms post-COVID-19 compared to females (pain intensity scores of 8.66 ± 1.15 versus 5.93 ± 2.01, p = 0.04) 1
- Younger patients (under 40 years) experience longer duration headache attacks post-COVID-19 (18.50 ± 16.44 minutes vs 5.5 ± 9.07 minutes in older patients, p = 0.045) 1
Characteristics of Post-COVID Migraines
- Bi-frontal and temporal regions are the most commonly reported sites (40.6% each) for de novo headaches following COVID-19 infection 1
- Most post-COVID de novo headaches (65.3%) resolve within 1 month of onset 1
- Post-COVID headaches typically present with migraine-like phenotype characteristics 1, 2
- New daily persistent headache (NDPH) has been reported as a specific post-COVID headache syndrome that can persist beyond the acute infection 2
Impact on Pre-existing Migraine
- Patients with pre-existing migraine experience significant worsening of their condition after COVID-19 infection 3, 4
- There is a significant increase in headache days post-COVID-19 (11.09 ± 8.45 days) compared to pre-infection baseline (8.66 ± 7.49 days, p < 0.006) 1
- Patients with pre-existing migraine show increased analgesic usage following COVID-19 infection (3.05 ± 2.09 vs 2.31 ± 1.65 pre-infection, p = 0.002) 1
- Six out of seven patients in one case series reported reduced efficacy of their pre-COVID migraine medications after infection, requiring treatment regimen changes 4
Pathophysiological Mechanisms
- The exact mechanism of post-COVID headache is not fully understood but may involve neuroinflammation 2
- Neuroinflammatory processes triggered by SARS-CoV-2 may play a significant role in the development of post-COVID headaches, as suggested by the positive response to immunomodulatory therapy in some cases 2
- COVID-19 affects the renin-angiotensin system through binding to ACE2 receptors, potentially leading to vascular dysregulation that could contribute to headache development 5
Clinical Implications and Management
- Immunomodulatory therapy, particularly short-term high-dose corticosteroids, has shown good therapeutic response in some cases of persistent post-COVID headaches 2
- Standard migraine treatments such as Botox and anti-calcitonin gene-related peptide (anti-CGRP) medications show varied success in managing post-COVID migraines 4
- Careful clinical evaluation of COVID-19 patients presenting with persistent headache should consider NDPH as a potential diagnosis 2
Risk Factors
- History of pre-existing headache disorders significantly increases the risk of developing headaches after COVID-19 1, 3, 6
- Male sex appears to be associated with more severe headache symptoms post-COVID-19 1
- Younger age (under 40 years) is associated with longer duration of headache attacks following COVID-19 infection 1