![]() The penetrance of brain parenchyma by COVID‐19 is not investigated in autopsy findings, yet. 11ħ4 with at least 1 gastrointestinal symptomĥ73 with, 72 without pulmonary involvementĨ03 health‐care workers with mild symptoms, questionnaire Headache was reported in 64/90 (71.1 %) health‐care workers with positive SARS‐CoV‐2, while it was present in 296/713 (41.5 %) health‐care workers with negative SARS‐CoV‐2. 10 Of the health‐care workers (n = 803) with mild symptoms, 90 were SARS‐CoV‐2 positive and headache was among the early symptoms associated with the positivity in the predictive statistical model together with anosmia, myalgia, ocular pain, general malaise, extreme tiredness, and fever, as reported in a questionnaire. They interpreted this finding as caused by their higher fevers and increased electrolyte imbalance, but no evidence was available in the report. 8, 9 Another study draws attention to nonclassical symptoms in 74 confirmed COVID‐19 cases with gastrointestinal symptoms out of 651 patients (11.4%) and indicated that 21.62% of them had significantly higher rates of headache compared to other patients without gastrointestinal symptoms. ![]() 7 Similarly, Wuhan group also reported a headache rate of 8% as a less common symptom, among the symptoms at onset of the illness. 6 In a series of 262 confirmed cases of the COVID‐19 in Beijing, the most common symptoms at the onset of illness were cited as fever, cough, fatigue, and dyspnea followed closely by headache with a rate of 6.5%. 3, 4, 5 A higher rate reported was 34% from Zhejiang province, China in a small series of 62 patients with a milder course compared to Wuhan, but no further details about the characteristics of the headache or prior headache history were given. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 A recent meta‐analysis (n = 3598 patients) and a handful of reports disclosed that headache is among the COVID‐19‐related symptoms with a rate mostly around 11%‐14%, in patients who had either died or recovered. The available reports related to headache symptom in patients with COVID‐19 do not contain any details about headache characteristics (Table (Table1 1). Nowadays, the reports on the neurological findings are increasing rapidly and headache seems to be the leader on the symptom list. Neurologists are involved in many places together with all other physicians and health personnel in the war against the pandemic. 1, 2 However, other manifestations such as headache, abdominal pain, diarrhea, loss of taste and smell, and frost bite like skin lesions have been added to the clinical spectrum, during the follow‐up of increased number of patients within 3 months. COVID‐19 is initially characterized by fever, sore throat, cough, and dyspnea, mainly manifestations of respiratory system. We concluded that as a common non‐respiratory symptom of COVID‐19, headache should not be overlooked, and its characteristics should be recorded with scrutiny.Īfter the emergence of a novel coronavirus named SARS‐CoV‐2, causing coronavirus disease 2019 (COVID‐19) with a severe and deadly pneumonia in Wuhan, China, our known world has changed dramatically. The possible pathophysiological mechanisms of headache include activation of peripheral trigeminal nerve endings by the SARS‐CoV‐2 directly or through the vasculopathy and/or increased circulating pro‐inflammatory cytokines and hypoxia. Symptomatic COVID‐19 patients, around 6%‐10%, also reported headache as a presenting symptom. The most striking features of the headache were sudden to gradual onset and poor response to common analgesics, or high relapse rate, that was limited to the active phase of the COVID‐19. ![]() According to our initial experience, significant features of headache presentation in the symptomatic COVID‐19 patients were new‐onset, moderate‐severe, bilateral headache with pulsating or pressing quality in the temporoparietal, forehead or periorbital region. Headache was reported in 11%‐34% of the hospitalized COVID‐19 patients, but clinical features of these headaches were totally missing in available publications. ![]() The reports on the neurological findings are increasing rapidly and headache seems to be the leader on the symptom list. However, other manifestations such as headache, abdominal pain, diarrhea, loss of taste and smell were added to the clinical spectrum, during the course of the COVID‐19 pandemic. After the emergence of a novel coronavirus named SARS‐CoV‐2, coronavirus disease 2019 (COVID‐19) was initially characterized by fever, sore throat, cough, and dyspnea, mainly manifestations of respiratory system.
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