We retrospectively analyzed clinical data of patients who were diagnosed with COVID-19 for the predictors of headache development. 

COVID-19, a multisystemic infection caused by the SARS-CoV2 virus, is associated with significant mortality and neurologic morbidity, including stroke, encephalopathy and neuromuscular disorders as well as less severe symptoms like headaches, muscle aches and anosmia that are important for case recognition and diagnosis. Little is known about the predictors and associations of headache in COVID-19.

We performed retrospective chart review of patients positive for SARS-CoV2 by nasopharyngeal swab in March and April 2020 at MGH, Boston, Massachusetts. This study was approved by our institutional review board. Demographic, medical comorbidity, radiologic and laboratory data were collected by electronic medical record review. Clinical manifestations were included starting on the date of COVID-19 onset, as identified by the patient’s clinical notes. Data was analyzed based on age, racial/ethnic background, body mass index, and associated symptoms. 

We identified 440 patients, 202 (45.9%) male and 238 (54%) female. Males more likely required admissions for inpatient treatment, had abnormal chest imaging or a clinical diagnosis of pneumonia. There is significantly different headache prevalence between patients aged below 50 (15.9%) and aged 50 or above (18.9%, p=0.0086). There was no difference in headache prevalence between BMI groups. Patients who had headaches were significantly more likely to also have had non-specific viral symptoms, including nausea/vomiting, nasal congestion, myalgia, ear pain ,eye pain, and fatigue as well as neurological symptoms of anosmia, hypogeusia, and dizziness.  Hispanics had significantly more headaches, nausea/vomiting, anosmia, myalgia, and nasal congestion than non-Hispanics, while non-Hispanics had significantly more fatigue.

Our results demonstrated age and ethnic predisposing factors for headache in COVID-19.  In addition, certain neurological symptoms are positive predictors for headache in COVID-19.