Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review

A review of the sequelae of post Covid-19 with neurological implications (post-viral syndrome)

Post Covid-19 conditions represent a medical challenge; a unified definition is not achieved after 5 years of the Pandemic. The incidence of Post Covid-19 conditions varies, nevertheless the neurological complications represent an important aspect in the spectrums of fields involved. The current perception is that varied manifestations and long-term complications of COVID-19 reflect underlying pathophysiological processes, including inflammatory, immune-mediated, and vascular mechanisms. These mechanisms underscore the complexity of COVID-19's impact including the nervous system and its potential for lasting effects. A number of symptoms are extremely severe and may also need neurologic attention including fatigue, cognitive disturbances, autonomic symptoms, headache, and sleep disorders. Post Covid-19 conditions are often of chronic nature. Management as in other chronic conditions should rely on the conventional diagnostic measures and management of symptoms irrespective of the temporal relation to the viral infection. To date Post Covid-19 conditions is only accepted as an additional or explanatory diagnosis.

Long-Term Persistent Headache After SARS-CoV-2 Infection: A Follow-Up Population-Based Study

BACKGROUND

Headache is a symptom of the long-COVID syndrome. The incidence and characteristics of de novo post-COVID headaches remain unclear. Our aim was to characterize new-onset headaches in a population-based prospective cohort of COVID-19 patients from the first pandemic wave.

METHODS

This study followed a prospective cohort of 732 COVID-19 patients consecutively diagnosed between March and June 2020. Neurological follow-up was performed face-to-face or by phone at 3, 12, and 24 months. A structured clinical questionnaire was used to characterize headaches before infection and 24 months postinfection.

RESULTS

Overall, 448 patients completed the 24-month follow-up, with a mean age of 51.6 years at SARS-CoV-2 infection; 272 (60.7%) were women. A prior history of headaches was reported by 115 (25.7%). Patients with either pre-existing or de novo persistent headaches were younger, more often women, and exhibited hyposmia, hypogeusia, and headache during the acute phase of infection. De novo persistent headaches occurred in 54 of 333 (16.2%) headache-naïve patients. Of these, 35 (64.8%) fulfilled migraine-like headache (MLH) criteria (mean age of 49.1 years at 24-month follow-up), with a cumulative incidence of 42/1000/year.

CONCLUSIONS

De novo persistent headaches are common 2 years after COVID-19, with MLH being the most frequent type. MLH incidence after COVID-19 is elevated and de novo "migraineurs-like" tend to be older compared to the general population. This is an important finding with potential implications for healthcare and quality of life, considering the high number of COVID-19 cases and the global burden of migraine.

The European Academy of Neurology NeuroCOVID-19 Task Force: A lesson for the future

BACKGROUND

The COVID-19 pandemic has made its mark on world history forever causing millions of deaths, and straining health systems, economies, and societies worldwide. The European Academy of Neurology (EAN) reacted promptly. A special NeuroCOVID-19 Task Force was set up at the beginning of the pandemic to promote knowledge, research, international collaborations, and raise awareness about the prevention and treatment of COVID-19-related neurological issues.

METHODS

Activities carried out during and after the pandemic by the EAN NeuroCOVID-19 Task Force are described. The main aim was to review all these initiatives in detail as an overarching lesson from the past to improve the present and be better prepared in case of future pandemics.

RESULTS

During the pandemic, the Task Force was engaged in several initiatives: the creation of the EAN NEuro-covid ReGistrY (ENERGY); the launch of several surveys (neurological manifestations of COVID-19 infection; the pandemic's impact on patients with chronic neurological diseases; the pandemic's impact of restrictions for clinical practice, curricular training, and health economics); the publication of position papers regarding the management of patients with neurological diseases during the pandemic, and vaccination hesitancy among people with chronic neurological disorders; and the creation of a dedicated "COVID-19 Breaking News" section in EANpages.

CONCLUSIONS

The EAN NeuroCOVID-19 Task Force was immediately engaged in various activities to participate in the fight against COVID-19. The Task Force's concerted strategy may serve as a foundation for upcoming global neurological emergencies.

Characteristics of Oral Adverse Effects following COVID-19 Vaccination and Similarities with Oral Symptoms in COVID-19 Patients: Taste and Saliva Secretory Disorders

Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear within 3 days of vaccination, and bitter taste is specifically impaired in some cases. Considering that oral adverse effects following COVID-19 vaccination share some characteristics with oral symptoms in COVID-19 patients, it is speculated that the spike protein derived from COVID-19 vaccination and SARS-CoV-2 infection may be pathophysiologically responsible for taste and saliva secretory disorders. This is because such spike protein has the potential to interact with ACE2 expressed on the relevant cells, produce proinflammatory cytokines, and form antiphospholipid antibodies. Our results do not deny the advantages of COVID-19 vaccination, but attention should be paid to post-vaccination oral effects in addition to COVID-19 oral symptoms. Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear within 3 days of vaccination, and bitter taste is specifically impaired in some cases. Considering that oral adverse effects following COVID-19 vaccination share some characteristics with oral symptoms in COVID-19 patients, it is speculated that the spike protein derived from COVID-19 vaccination and SARS-CoV-2 infection may be pathophysiologically responsible for taste and saliva secretory disorders. This is because such spike protein has the potential to interact with ACE2 expressed on the relevant cells, produce proinflammatory cytokines, and form antiphospholipid antibodies. Our results do not deny the advantages of COVID-19 vaccination, but attention should be paid to post-vaccination oral effects in addition to COVID-19 oral symptoms.