A 61-year-old woman with osteopenia managed with calcium and Vitamin D supplements and hypothyroidism on levothyroxine comes to a local walk-in clinic after a potential COVID-19 exposure. She gets a PCR nasal swab and was informed that the results should be available within the hour. While waiting for the results she develops a headache that she describes as a "tight band around my head" with some tenderness in her shoulder muscles. However, once the results return as negative her headache slowly begins to improve.
What was the most likely etiology of her headache?
- A) Bacterial meningitis
- B) Tension headache
- C) Cluster headache
- D) Migraine headache
- E) Subarachnoid hemorrhage
B) Tension headache
The take home message is that common symptoms of COVID-19 infection include: fever or chills; cough; shortness of breath; fatigue; muscle and body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea. Some studies have shown that people with COVID-19 may even get a headache before they notice any breathing or respiratory problems. Pounding headaches can continue for weeks or even months after an individual tests positive for COVID-19. Headaches are one of the most common symptoms being experienced by a group known as COVID long haulers or those with lingering issues related to the SARS-CoV-2 infection. However, given the negative PCR result and the classic description of the headache in the setting of the patient being sleep deprived and stressed likely makes this a tension headache.
This is not a cluster headache which typically occurs in cyclical patterns or cluster periods. Cluster headaches can awaken individuals in the middle of the night with intense pain in or around one eye on one side of the head. The bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop.
This is unlikely to be a migraine headache which classically presents with severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities. For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
This is not a clinical presentation for bacterial meningitis or subarachnoid hemorrhagic, both of which can present with “meningismus,” which is a clinical syndrome of signs and symptoms that are suggestive of meningeal irritation. Symptoms may include photophobia, neck stiffness and seizures.
Dr. Raj Dasgupta
Dr. Raj Dasgupta