Virtual Issue: COVID-19 and headache.

The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) has been responsible for the COVID‐19 pandemic for over a year now. Though primarily a respiratory infection, SARS‐CoV2 has demonstrated neurotropism centrally and peripherally, often with persisting neurologic symptoms beyond resolution of systemic symptoms like dyspnea and fever.

Headache can broadly be associated with COVID‐19 infection with overall prevalence ranging widely, encompassing both secondary and primary headache disorders (Table 1). There has been robust COVID‐19 literature this past year, including numerous studies published in Headache. Several plausible mechanisms for COVID‐19‐associated headache have been postulated, namely via ACE2 host‐receptor cellular entry with subsequent role in trigeminovascular activation, direct viral invasion, and cytokine release syndrome. Though the exact phenotype of headache directly attributed to COVID‐19 infection remains without specificity, we know it is often an early symptom, persistent, even isolated, and may not reliably correlate with COVID‐19 disease severity.

TABLE 1

Secondary and primary headache disorders associated with COVID‐19 infection

Headache category	Headache entity
Secondary headache	Headache attributed to systemic viral infection
	Cytokine release syndrome
	Other causes related to direct COVID‐19 infection (vascular, non‐vascular)
Primary headache	Index headache disorder (usually migraine) triggered by viral infection itself
	Stress let‐down after COVID‐19 infection subsides—migraine trigger
	Stressful life event, post‐traumatic stress disorder related to COVID‐19 infection inducing episodic migraine progression to chronic migraine
	De novo continuous headache with onset associated with COVID‐19 infection—new daily persistent headache

People both with and without pre‐existing headache disorders have experienced headache associated with COVID‐19. Frontline workers, and now the general population, wearing personal protective equipment have developed headache (probably attributed to external‐compression headache). Clinicians have had to change practice, now heavily weighing the safety of previous commonly used headache treatments like non‐steroidal anti‐inflammatory drugs and corticosteroids and utilizing pragmatic at‐home bridging therapies to replace in‐office procedures and acute care visits. , The need for social distancing has further led to a drastic healthcare system‐wide shift toward telemedicine and other virtual services, which is also providing a renewed interest in more contemporary applications of holistic care, such as smartphone‐based mindfulness and behavioral applications. Headache education has required rapid evolution as the majority of neurology residents and fellows, as well as other graduate, undergraduate and continuing medical education training programs, have had their formative experiences in 2020‐2021 impacted by the pandemic. Finally, with vaccinations upon us, we can expect upcoming examinations of their impact on our patients and delivery of care.

Although scientific information regarding headache and COVID‐19 is constantly evolving, we appreciate Headache as a premier destination advancing this science and our larger understanding of headache as a symptom of this infection, its interaction with secondary and primary headache disorders acutely and chronically, as well as its impact on our delivery of care, well‐being, and education efforts. This very timely virtual issue compiles relevant manuscripts published in Headache over the previous year addressing COVID‐19 as it relates to various aspects of headache medicine.

CONFLICT OF INTEREST

Dr. Bobker is a headache medicine fellow at UCSF and serves as an Assistant Editor of the Residents & Fellows Section for Headache. She has nothing to disclose. Dr. Robbins serves on the board of directors of the American Headache Society, in editorial roles for Headache and Current Pain and Headache Reports, and receives book royalties from Wiley.

Supplementary Material

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