COVID-19-induced headache in Boston and the vicinity

Background Coronavirus disease 2019 (COVID-19) causes mild symptoms to severe illness in the nervous system. Among the wide-ranged symptomology, headache is a common neurological symptom reported by COVID-19 patients. However, the prevalence, comorbidities, and ethnic susceptibilities of COVID-19-induced headaches are not well-defined.    Methods We performed a retrospective chart review of patients who tested positive for SARS-CoV2 by reverse transcriptase -polymerase chain reaction (RT-PCR) in March and April 2020 at Massachusetts General Hospital, Boston, Massachusetts, USA. An electronic medical record review was performed to collect demographic data, major COVID-19 symptomology, and results of radiologic and laboratory tests. Data were recorded starting on the disease onset, as identified by the patient’s clinical notes. The demographical trends and prevalence of headache and comorbid symptoms were statistically analyzed. Results We identified 450 patients, 202 (44.9%) male and 248 (55.1%) female, who tested positive for COVID-19 in the study. Common symptoms included cough (66.4%), fever,(58.9%), fatigue (30.9%), and sore throat (29.6%). Forty-six percent of patients had shortness of breath, 32% had evidence of pneumonia, and 26% needed hospitalization. Gender predominance is significant in developing a sore throat, nasal congestion, hypogeusia, headache, ear pain in females, and pneumonia and inpatient hospitalization in males. Younger patients (< 50) were more likely to develop sore throat, fatigue, anosmia, hypogeusia, ear pain, myalgia /arthralgia, and headache. In contrast, older (> 50) patients were prone to develop pneumonia and required hospitalization. Compared to non-Hispanic ethnic populations, a significantly higher number of Hispanic patients reported headaches, nausea/vomiting, nasal congestion, fever, fatigue, anosmia, and myalgia/arthralgia compared to non-Hispanics, suggesting an ethnic susceptibility in COVID-19 symptomatology. Overall, patients who developed headaches were younger and more likely to have mild viral symptoms, pain, and neurological symptoms but not severe respiratory symptoms (shortness of breath and pneumonia) and hospitalization.  Conclusions Our results demonstrated gender, age, and ethnic factors in COVID symptomatology and identified that mild viral, painful, and neurological symptoms are positive predictors for headache development in COVID-19.