Prevalence |
14%4646 Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(1):34.
26%4646 Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(1):34.
|
30% – 78%44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.
|
39.68%33 López JT, García-Azorín D, Planchuelo-Gómez Á, García-Iglesias C, Dueñas-Gutiérrez C, Guerrero ÁL. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia. 2020;40(13):1432-42.,55 Caronna E, Ballvé A, Llauradó A, Gallardo VJ, Ariton DM, Lallana S, López Maza S, Olivé Gadea M, Quibus L, Restrepo JL, Rodrigo-Gisbert M, Vilaseca A, Hernandez Gonzalez M, Martinez Gallo M, Alpuente A, Torres-Ferrus M, Pujol Borrell R, Alvarez-Sabin J, Pozo-Rosich P. Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia. 2020;40(13):1410-21.,66 Gonzalez-Martinez A, Fanjul V, Ramos C, Serrano Ballesteros J, Bustamante M, Villa Martí A, Álvarez C, García Del Álamo Y, Vivancos J, Gago-Veiga AB. Headache during SARS-CoV-2 infection as an early symptom associated with a more benign course of disease: a case-control study. Eur J Neurol. 2021;28(10):3426-36.,1515 Barut BÖ, Ulutaş S, Şahbaz G, Çelik A, Kara T, Öngörü P. COVID-19 related headache and its clinical characteristics. Neurol Asia. 2021;26(1):101–6. https://www.neurology-asia.org/articles/neuroasia-2021-26(1):101. https://www.neurology-asia.org/articles/...
,1616 Bilge N, Kesmez C F, Alay H. The relationship of headache with inflammatory serum parameters and disease severity in COVID-19 patients. Duzce Med J. 2020;22 (Special Issue 1):44-50.,1717 García-Azorín D, Trigo J, Talavera B, Martínez-Pías E, Sierra Á, Porta-Etessam J, Arenillas J F, Guerrero ÁL. Frequency and type of red flags in patients with covid-19 and headache: a series of 104 hospitalized patients. Headache. 2020a;60(8):1664-72.,1818 Hussein M, Fathy W, Eid RA, Abdel-Hamid HM, Yehia A, Sheemy MS, Ragaie C, Dahshan A, Rizk HI, Laz N, Magdy R. Relative frequency and risk factors of COVID-19 related headache in a sample of Egyptian population: a hospital-based study. Pain Med. 2021;22(9):2092-9.,1919 Kacem I, Gharbi A, Harizi C, Souissi E, Safer M, Nasri A, Letaief H, Akkari M, Hechaichi A, Mrabet S, Dhaouadi S, Ben Djebara M, Derouiche S, Gargouri A, Chahed M, Ben Alaya N, Gouider R. Characteristics, onset, and evolution of neurological symptoms in patients with COVID-19. Neurol Sci. 2021;42(1):39-46,2020 Karadaş Ö, Öztürk B, Sonkaya AR, Taşdelen B, Özge A, Bolay H. Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6. Neurol Sci. 2021;42(5):1665-73.,2121 Liu J, Li S, Liu J, Liang B, Wang X, Wang H, Li W, Tong Q, Yi J, Zhao L, Xiong L, Guo C, Tian J, Luo J, Yao J, Pang R, Shen H, Peng C, Liu T, Zhang Q, Wu J, Xu L, Lu S, Wang B, Weng Z, Han C, Zhu H, Zhou R, Zhou H, Chen X, Ye P, Zhu B, Wang L, Zhou W, He S, He Y, Jie S, Wei P, Zhang J, Lu Y, Wang W, Zhang L, Li L, Zhou F, Wang J, Dittmer U, Lu M, Hu Y, Yang D, Zheng X. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763.,2222 Magdy R, Hussein M, Ragaie C, Abdel-Hamid HM, Khallaf A, Rizk HI, Dahshan A. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia. 2020;40(13):1422-31.,2323 Osikomaiya B, Erinoso O, Wright KO, Odusola AO, Thomas B, Adeyemi O, Bowale A, Adejumo O, Falana A, Abdus-Salam I, Ogboye O, Osibogun A, Abayomi A. ‘Long COVID’: persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria. BMC Infect Dis. 2021;21(1):304.,2424 Planchuelo-Gómez Á, Trigo J, de Luis-García R, Guerrero ÁL, Porta-Etessam J, García-Azorín D. Deep Phenotyping of Headache in Hospitalized COVID-19 Patients via Principal Component Analysis. Front Neurol. 2020;11:583870.,2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51.,2626 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapa JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D; “Pain in the Pandemic Initiative Collaborators”. Prevalence and characteristics of new-onset pain in COVID-19 survivours, a controlled study. Eur J Pain. 2021;25(6):1342-354.,2727 Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E, Çağatay AA, Baykan B. Headache characteristics in COVID-19 pandemic-a survey study. J Headache Pain. 2020;21(1):121.,2828 Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, Guerra L, Zaccaroni S, Cortelli P, Michelucci R, Liguori R. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci. 2020;41(8):2029-31.,2929 Poncet-Megemont L, Paris P, Tronchere A, Salazard J P, Pereira B, Dallel R, Aumeran C, Beytout J, Jacomet C, Laurichesse H, Lesens O, Mrozek N, Vidal M, Moisset X. High Prevalence of headaches during covid-19 infection: a retrospective cohort study. Headache. 2020;60(10):2578-82.,3030 Trigo J, García-Azorín D, Planchuelo-Gómez Á, Martínez-Pías E, Talavera B, Hernández-Pérez I, Valle-Peñacoba G, Simón-Campo P, de Lera M, Chavarría-Miranda A, López-Sanz C, Gutiérrez-Sánchez M, Martínez-Velasco E, Pedraza M, Sierra Á, Gómez-Vicente B, Arenillas J F, Guerrero ÁL. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. J Headache Pain. 2020;21(1):94.,3131 Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, Gaudy-Graffin C, Grammatico-Guillon L, Bernard L. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-63.,3232 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100.,3333 Leth S, Gunst JD, Mathiasen V, Hansen K, Søgaard O, Østergaard L, Jensen-Fangel S, Storgaard M, Agergaard J. Persistent symptoms in patients recovering from COVID-19 in Denmark. Open Forum Infect Dis. 2021;8(4):ofab042.,3434 García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021;11(1):14674
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Age range |
18 – 443939 Burch R. Migraine and tension-type headache: diagnosis and treatment. Med Clin North Am. 2019;103(2):215-33.
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30 – 3944 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.
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33 – 591616 Bilge N, Kesmez C F, Alay H. The relationship of headache with inflammatory serum parameters and disease severity in COVID-19 patients. Duzce Med J. 2020;22 (Special Issue 1):44-50.,1717 García-Azorín D, Trigo J, Talavera B, Martínez-Pías E, Sierra Á, Porta-Etessam J, Arenillas J F, Guerrero ÁL. Frequency and type of red flags in patients with covid-19 and headache: a series of 104 hospitalized patients. Headache. 2020a;60(8):1664-72.,2020 Karadaş Ö, Öztürk B, Sonkaya AR, Taşdelen B, Özge A, Bolay H. Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6. Neurol Sci. 2021;42(5):1665-73.,2222 Magdy R, Hussein M, Ragaie C, Abdel-Hamid HM, Khallaf A, Rizk HI, Dahshan A. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia. 2020;40(13):1422-31.,2929 Poncet-Megemont L, Paris P, Tronchere A, Salazard J P, Pereira B, Dallel R, Aumeran C, Beytout J, Jacomet C, Laurichesse H, Lesens O, Mrozek N, Vidal M, Moisset X. High Prevalence of headaches during covid-19 infection: a retrospective cohort study. Headache. 2020;60(10):2578-82.,3434 García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021;11(1):14674
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Area |
Unilateral pain. |
Mainly frontotemporal44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
Bilateral pain44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
Four orofacial areas. |
Bilateral pain33 López JT, García-Azorín D, Planchuelo-Gómez Á, García-Iglesias C, Dueñas-Gutiérrez C, Guerrero ÁL. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia. 2020;40(13):1432-42.,1515 Barut BÖ, Ulutaş S, Şahbaz G, Çelik A, Kara T, Öngörü P. COVID-19 related headache and its clinical characteristics. Neurol Asia. 2021;26(1):101–6. https://www.neurology-asia.org/articles/neuroasia-2021-26(1):101. https://www.neurology-asia.org/articles/...
,2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51.,2727 Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E, Çağatay AA, Baykan B. Headache characteristics in COVID-19 pandemic-a survey study. J Headache Pain. 2020;21(1):121.,3232 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100.. |
Frontal pain1919 Kacem I, Gharbi A, Harizi C, Souissi E, Safer M, Nasri A, Letaief H, Akkari M, Hechaichi A, Mrabet S, Dhaouadi S, Ben Djebara M, Derouiche S, Gargouri A, Chahed M, Ben Alaya N, Gouider R. Characteristics, onset, and evolution of neurological symptoms in patients with COVID-19. Neurol Sci. 2021;42(1):39-46,2020 Karadaş Ö, Öztürk B, Sonkaya AR, Taşdelen B, Özge A, Bolay H. Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6. Neurol Sci. 2021;42(5):1665-73.,2424 Planchuelo-Gómez Á, Trigo J, de Luis-García R, Guerrero ÁL, Porta-Etessam J, García-Azorín D. Deep Phenotyping of Headache in Hospitalized COVID-19 Patients via Principal Component Analysis. Front Neurol. 2020;11:583870.. |
Diffuse or holocranial pain 1515 Barut BÖ, Ulutaş S, Şahbaz G, Çelik A, Kara T, Öngörü P. COVID-19 related headache and its clinical characteristics. Neurol Asia. 2021;26(1):101–6. https://www.neurology-asia.org/articles/neuroasia-2021-26(1):101. https://www.neurology-asia.org/articles/...
,2222 Magdy R, Hussein M, Ragaie C, Abdel-Hamid HM, Khallaf A, Rizk HI, Dahshan A. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia. 2020;40(13):1422-31.,3434 García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021;11(1):14674. |
Triggers |
Routine physical activity44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
Not aggravated by routine physical activity44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
Cough33 López JT, García-Azorín D, Planchuelo-Gómez Á, García-Iglesias C, Dueñas-Gutiérrez C, Guerrero ÁL. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia. 2020;40(13):1432-42.,2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51.,3232 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100..
Head movements2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51..
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Pathophysiology |
Activation and sensitization of trigeminovascular pathways, as well as the brain stem and diencephalic nuclei4949 Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622..
Activation of descending pathways that facilitate the processing of neuronal pain signals in the spinal cord4949 Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622.. Suppression of inhibitory descending pathways of pain processing4949 Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622..
Activation of peripheral sensory fibers that innervate intracranial blood vessels and dura mater4747 Khan J, Asoom LIA, Sunni AA, Rafique N, Latif R, Saif SA, Almandil NB, Almohazey D, AbdulAzeez S, Borgio J F. Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. Biomed Pharmacother. 2021;139:111557..
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Neurobiological basis with both peripheral and central mechanisms contributing to the pain4545 Robbins MS. Diagnosis and management of headache: a review. JAMA. 2021;325(18):1874-85..
Sensitization of peripheral myofascial nociceptors4848 Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21(10):56..
Sensitization of secondary neurons in the dorsal horn of the spinal cord or trigeminal nucleus4848 Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21(10):56..
Sensitization of supraspinal neurons4848 Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21(10):56..
Decreased antinociceptive activity of supraspinal structures4848 Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21(10):56..
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Direct viral invasion of the trigeminal nerve by the SARS-COV-2 virus3535 Bolay H, Gül A, Baykan B. COVID-19 is a Real Headache! Headache. 2020;60(7):1415-21..
Involvement of endothelial cells with high expression of angiotensin-converter enzyme 2 (ACE2), and inflammatory process3535 Bolay H, Gül A, Baykan B. COVID-19 is a Real Headache! Headache. 2020;60(7):1415-21..
Coagulopathy or hypoxemia3535 Bolay H, Gül A, Baykan B. COVID-19 is a Real Headache! Headache. 2020;60(7):1415-21..
Stress88 Pohl H, Gantenbein AR. COVID-19 and Headaches. Praxis (Bern 1994). 2021;110(4):201–6..
Intracranial pressure88 Pohl H, Gantenbein AR. COVID-19 and Headaches. Praxis (Bern 1994). 2021;110(4):201–6..
|
Phenotypic features |
Pulsating quality.
Moderate or severe pain intensity44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211..
|
Pressing or tightening (non-pulsating) quality.
Mild or moderate intensity44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211..
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Oppressive symptomatology33 López JT, García-Azorín D, Planchuelo-Gómez Á, García-Iglesias C, Dueñas-Gutiérrez C, Guerrero ÁL. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia. 2020;40(13):1432-42.,1515 Barut BÖ, Ulutaş S, Şahbaz G, Çelik A, Kara T, Öngörü P. COVID-19 related headache and its clinical characteristics. Neurol Asia. 2021;26(1):101–6. https://www.neurology-asia.org/articles/neuroasia-2021-26(1):101. https://www.neurology-asia.org/articles/...
,2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51.,2727 Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E, Çağatay AA, Baykan B. Headache characteristics in COVID-19 pandemic-a survey study. J Headache Pain. 2020;21(1):121.,3232 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100..
Pulsatile pain especially in individuals with headaches pre-infection77 Porta-Etessam J, Matías-Guiu JA, González-García N, Gómez Iglesias P, Santos-Bueso E, Arriola-Villalobos P, García-Azorín D, Matías-Guiu J. Spectrum of headaches associated with SARS-CoV-2 infection: study of healthcare professionals. Headache. 2020;60(8):1697-704.,2525 Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia. 2020;40(13):1443-51..
|
Duration of headache symptomatology |
4 to 72 hours44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
30 min to 7 days44 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. (2018). Cephalalgia. 2018;38(1), 1-211.. |
Mean of 5.6 hours3232 Demiryurek BE, Yakşi E, Yakşi O, Özsari E, Türel CA, Çelik K. The relationship between headache and hiposmi-anosmi in covid-19 patients. Neurol Asia. 2021;26(1):95-100.. |
Drug treatment |
Simple analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, lasmiditan4242 Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17(11):1318-25.. |
Simple analgesics and non-steroidal anti-inflammatory drugs[4242 Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17(11):1318-25.]. |
Simple analgesics2020 Karadaş Ö, Öztürk B, Sonkaya AR, Taşdelen B, Özge A, Bolay H. Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6. Neurol Sci. 2021;42(5):1665-73.,2828 Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, Guerra L, Zaccaroni S, Cortelli P, Michelucci R, Liguori R. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci. 2020;41(8):2029-31.,3434 García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, Cornejo A, Cubero M, Gil A, García-Iglesias C, Lozano AG, Martínez Badillo C, Montilla C, Mora M, Núñez G, Paniagua M, Pérez C, Rojas M, Ruiz M, Sierra L, Hurtado ML, Guerrero Peral ÁL. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021;11(1):14674. |