Clinical and Imaging Analysis of Headaches in Neurological Post-acute Sequelae of SARS-CoV-2 Infection
Tyler Kuhns1, Jaime Imitola2, Shivam Patel1
1University of Connecticut School of Medicine, 2UConn Health MS center
Objective:
To determine risk factors associated with headache-predominant post-acute sequelae of COVID syndrome (PASC) versus PASC without headache, as well as differences in brain MRI in these two cohorts.
Background:
PASC is an emerging and highly prevalent disease that frequently involves neurologic symptoms such as fatigue, “brain fog”, and headache. Currently, there is a relative paucity of data describing risk factors for development of a headache-predominant PASC phenotype.
Design/Methods:
This retrospective chart review study identified 56 patients referred to a neuro-immunologist for evaluation of new neurologic symptoms following confirmed COVID-19 infection. Demographic data and past medical history were collected, and white matter hyperintensities were quantified from axial T2 FLAIR images of the brain using the Schelten score.
Results:
PASC patients complaining of headache were more likely than their counterparts with other neurologic PASC symptoms to be younger (median age 50 vs 57), female (74% vs 63%), and have a higher BMI (median 32.9 vs 28.1) and/or sleep apnea (10/34 [29.4%] vs 2/22 [9.0%]). Interestingly, the PASC headache phenotype was more likely to occur in individuals with a prior headache condition (9/34 [26.4%] vs 2/22 [9.0%]). The non-headache PASC cohort had greater amount of periventricular white matter hyperintensities (mean Schelten score 2.42 vs 1.67).
Conclusions:
Patients at risk of developing the PASC-associated headache phenotype are generally at risk of developing a primary headache disorder, such as women and those with a higher BMI. The absence of changes on brain MRI suggests that PASC headache is not due to a direct CNS insult as a result of COVID, such as a demyelinating or vascular process. This study is limited by its small sample size and retrospective design; further research is needed to better characterize risk factors and long term outcomes in PASC patients with headache.