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Background: Headache is one of the most frequently reported symptoms in post-COVID patients. The clinical phenotype of COVID-19 headache combines phenotypic features of both tension-type headache (TTH) and migraine. We aimed to assess the effectiveness, side effects and predictors of amitriptyline (AMT) response in a real-world study setting. Methods: We performed an observational multicentric study with a retrospective cohort. All consecutive patients with confirmed COVID-19 infection who received AMT for post-COVID headache from March 2020 to May 2021 were included. Response was evaluated by the reduction in the number of headache days per month (HDM) between weeks 8 and 12, compared with the baseline. We explored which variables were associated with a higher probability of response to AMT. Results: Forty-eight patients were eligible for the study, 40/48 (83.3%) females, aged 46.85 (SD: 13.59) years. Patients had history of migraine 15/48 (31.3%) or TTH 5/48 (10.4%). The mean reduction of HDM was 9.6 (SD: 10.9; 95% CI 6.5, 12.7) days. Only 2/48 (5%) of patients discontinued AMT due to poor tolerability. History of TTH (10.9, 95% CI 1.3, 20.6) and nausea (− 8.5, 95% CI − 14.6, − 2.5) were associated with AMT response. Conclusions: This study provides real-world evidence of the potential benefit of AMT in patients with post-COVID-19 headache, especially in patients with history of TTH and without concomitant nausea. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to determine the clinical characteristics of migraine with aura (MA) as well as the frequency and patterns of perfusion‐computed tomography (PCT) alterations, in a series of patients with MA mimicking acute ischemic stroke. Background: MA is one of the most frequent stroke mimics, following seizures and psychiatric disorders. Previous case reports and short series have reported abnormal PCT patterns in patients with MA. Methods: We conducted a retrospective cohort study including all consecutive patients presenting with focal neurological symptoms during complete multimodal CT including baseline CT, angio‐CT, and PCT with a final diagnosis of MA. We collected demographic data and clinical information about MA variables using the hospital electronic database. Results: We found 25 patients with a final diagnosis of MA among 1761 patients who attended our stroke center with complete multimodal CT (1.4% [95% CI: 0.9–2.1]). Among them, 14/25 (56%) were women, average age 38.7 years (SD 12.5), and 16/25 (64%) had a previous history of migraine. The most frequent type of aura was sensory. The median time elapsed between the onset of symptoms and CT was 171 min (IQR: 119–244). PCT alteration was found in 3/25 (12%) consisting of a hypoperfusion pattern not restricted to a vascular territory. The three patients had aphasia as the presenting symptom. Conclusion: This is, to the best of our knowledge, the largest series of patients with MA managed as presumed stroke with clinical characteristics and PCT. In our study, most patients were young and had a prior history of migraine. PCT was normal in 88% of cases, with patients being still symptomatic by the time they were scanned. Further research will clarify the presence and type of PCT alterations in this entity. [ABSTRACT FROM AUTHOR]

Background and purpose: Headache is an important manifestation during SARS‐CoV‐2 infection. In this study, the aim was to identify factors associated with headache in COVID‐19 and headache characteristics. Methods: This case–control study includes COVID‐19 hospitalized patients with pneumonia during March 2020. Controls comprise COVID‐19 patients without headache and the cases are COVID‐19 patients with headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by semi‐structured telephonic interview after discharge. Results: Of a total of 379 COVID‐19 patients, 48 (13%) developed headache. Amongst these, 30 (62%) were men and the median age was 57.9 (47–73) years. Headache was associated with younger age, fewer comorbidities and reduced mortality, as well as with low levels of C‐reactive protein, mild acute respiratory distress syndrome and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D‐dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, whilst urea levels, beta‐lactamic treatment and hypertension were negatively associated with headache. COVID‐19‐associated headache characteristics were available for 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%) patients, of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and of holocranial 8/19 (42%) or temporal 7/19 (37%) localization. Conclusions: Our results show that headache is associated with a more benign SARS‐CoV‐2 infection. COVID‐19‐associated headache appears as an early symptom and as a novel headache with characteristics of headache attributed to systemic viral infection. Further research addressing the underlying mechanisms to confirm these findings is warranted. [ABSTRACT FROM AUTHOR]

Objective Previous studies have demonstrated that emotional stress, changes in lifestyle habits and infections can worsen the clinical course of migraine. We hypothesize that changes in habits and medical care during coronavirus disease 2019 (COVID-19) lockdown might have worsened the clinical course of migraine. Design Retrospective survey study collecting online responses from migraine patients followed-up by neurologists at three tertiary hospitals between June and July 2020. Methods We used a web-based survey that included demographic data, clinical variables related with any headache (frequency) and migraine (subjective worsening, frequency, and intensity), lockdown, and symptoms of post-traumatic stress. Results The response rate of the survey was 239/324 (73.8%). The final analysis included 222 subjects. Among them, 201/222 (90.5%) were women, aged 42.5 ± 12.0 (mean±SD). Subjective improvement of migraine during lockdown was reported in 31/222 participants (14.0%), while worsening in 105/222 (47.3%) and was associated with changes in migraine triggers such as stress related to going outdoors and intake of specific foods or drinks. Intensity of attacks increased in 67/222 patients (30.2%), and it was associated with the subjective worsening, female sex, recent insomnia, and use of acute medication during a headache. An increase in monthly days with any headache was observed in 105/222 patients (47.3%) and was related to symptoms of post-traumatic stress, older age and living with five or more people. Conclusions Approximately half the migraine patients reported worsening of their usual pain during the lockdown. Worse clinical course in migraine patients was related to changes in triggers and the emotional impact of the lockdown. [ABSTRACT FROM AUTHOR]

Background: Headache is a frequent symptoms of coronavirus disease 2019 (COVID-19). Its long-term evolution remains unknown. We aim to evaluate the long-term duration of headache in patients that presented headache during the acute phase of COVID-19. Methods: This is a post-hoc multicenter ambisective study including patients from six different third-level hospitals between 1 March and 27 April 2020. Patients completed 9 months of neurological follow-up. Results: We included 905 patients. Their median age was 51 (IQR 45–65), 66.5% were female, and 52.7% had a prior history of primary headache. The median duration of headache was 14 (6–39) days; however, the headache persisted after 3 months in 19.0% (95% CI: 16.5–21.8%) and after 9 months in 16.0% (95% confidence interval: 13.7–18.7%). Headache intensity during the acute phase was associated with a more prolonged duration of headache (Hazard ratio 0.655; 95% confidence interval: 0.582–0.737). Conclusion: The median duration of headache was 2 weeks, but in approximately a fifth of patients it became persistent and followed a chronic daily pattern. [ABSTRACT FROM AUTHOR]