Long-Term Persistent Headache After SARS-CoV-2 Infection: A Follow-Up Population-Based Study.

Background: Headache is a symptom of the long-COVID syndrome. The incidence and characteristics of de novo post-COVID headaches remain unclear. Our aim was to characterize new-onset headaches in a population-based prospective cohort of COVID-19 patients from the first pandemic wave.

Methods: This study followed a prospective cohort of 732 COVID-19 patients consecutively diagnosed between March and June 2020. Neurological follow-up was performed face-to-face or by phone at 3, 12, and 24 months. A structured clinical questionnaire was used to characterize headaches before infection and 24 months postinfection.

Results: Overall, 448 patients completed the 24-month follow-up, with a mean age of 51.6 years at SARS-CoV-2 infection; 272 (60.7%) were women. A prior history of headaches was reported by 115 (25.7%). Patients with either pre-existing or de novo persistent headaches were younger, more often women, and exhibited hyposmia, hypogeusia, and headache during the acute phase of infection. De novo persistent headaches occurred in 54 of 333 (16.2%) headache-naïve patients. Of these, 35 (64.8%) fulfilled migraine-like headache (MLH) criteria (mean age of 49.1 years at 24-month follow-up), with a cumulative incidence of 42/1000/year.

Conclusions: De novo persistent headaches are common 2 years after COVID-19, with MLH being the most frequent type. MLH incidence after COVID-19 is elevated and de novo "migraineurs-like" tend to be older compared to the general population. This is an important finding with potential implications for healthcare and quality of life, considering the high number of COVID-19 cases and the global burden of migraine.