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Long-Term Persistent Headache After SARS-CoV-2 Infection: A Follow-Up Population-Based Study
Lénia Silva1, Joana Fernandes1, Rui Lopes1
1Neurology Department, Centro Hospitalar Universitário Do Porto, ULS Santo António, Porto, Portugal.
European Journal of Neurology
|May 19, 2025
Summary
New-onset persistent headaches, particularly migraine-like headaches (MLH), are common two years after COVID-19 infection. This study highlights an elevated incidence of de novo MLH post-COVID-19.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Headache is a recognized symptom of long-COVID syndrome.
- The incidence and characteristics of new-onset headaches following COVID-19 infection are not well understood.
- This study aimed to characterize de novo headaches in a population-based prospective cohort of COVID-19 patients.
Purpose of the Study:
- To characterize the incidence and features of new-onset headaches in individuals who did not previously experience headaches, following COVID-19 infection.
- To assess the long-term (24-month) prevalence and type of persistent headaches after SARS-CoV-2 infection.
Main Methods:
- Prospective cohort study of 732 COVID-19 patients diagnosed between March-June 2020.
- Neurological follow-up at 3, 12, and 24 months via face-to-face or phone consultations.
- Structured clinical questionnaire to assess headache history before and 24 months post-infection.
Main Results:
- 448 patients completed 24-month follow-up; mean age 51.6 years, 60.7% female.
- De novo persistent headaches occurred in 16.2% (54/333) of headache-naïve patients.
- Migraine-like headaches (MLH) criteria were met by 64.8% (35/54) of these patients, with a cumulative incidence of 42/1000/year.
Conclusions:
- De novo persistent headaches are common two years post-COVID-19, with MLH being the most frequent type.
- The incidence of MLH following COVID-19 is elevated.
- Individuals developing de novo MLH post-COVID-19 tend to be older than the general migraine population, with significant implications for public health and quality of life.
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