Headaches can be major symptom of Covid-19, reveals case study

Researchers from the Institute of Human Behavior and Allied Sciences in India carried a case study of a 15-year-old boy who was admitted to an emergency room after reporting a severe headache.

According to the study published in the journal Headache, the throbbing headache started suddenly and occurred every 5–10 minutes. The boy was also vomiting and was sensitive to light.

The researchers noted that the condition exacerbated when he woke up in morning and increased when bending forward. Although the boy had a low fever five days before the onset of the headache, there were no respiratory symptoms like cough, sore throat, or loss of smell.

Furthermore, eye examination and a brain MRI did not reveal any abnormalities. Routine blood tests were also normal.

However, after thorough analysis, the researchers found increased pressure of 30 cm of water when they examined the cerebrospinal fluid. Test for viral pathogens like mumps, varicella, and enterovirus was negative.

Doctors started the patient on intravenous fluids, acyclovir, and paracetamol. After five days of treatment, the boy was conscious and had no behavioral symptoms. However, his headache did not improve, and did not respond to painkillers.

After conducting a nasal and throat swab test, the boy tested positive for the coronavirus. But the cerebrospinal fluid was negative for the virus. A repeat test of the cerebrospinal fluid still showed increased pressure of 28 cm of water, with two cells, both lymphocytes.

Earlier studies have also shown that headache has been a persistent symptom of the novel coronavirus. Literature reports show about 11–14 per cent of Covid-19 patients have reported headaches. Studies of patients in Beijing, China, showed headaches to be a common symptom in about 6.5 per cent of patients.

According to previous reports, ACE2 receptor cells’ expression in the brain could affect trigeminovascular activation and headache.

In the new study, the authors speculated that the headache is likely the result of the body’s immune response to SARS-CoV-2, with changes in cerebrospinal fluid production and resorption, resulting in increased intracranial pressure, which can lead to cerebral edema because of cytokines or infection of the endothelium.

“We already know that SARS-CoV-2 has neurotrophic potential, so in the current pandemic headache as a complaint should not be ignored especially any new-onset headache,” wrote the authors.

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