Brain Structural Abnormalities in Patients with Post-COVID-19 Headache.

IF 3.2 Q2 CLINICAL NEUROLOGY

Neurology International Pub Date : 2025-03-26 DOI:10.3390/neurolint17040050

Klaudia Széphelyi, Szilvia Kóra, Gergely Orsi, József Tollár

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Abstract

Background/objectives: Headache is one of the most common neurological symptoms associated with COVID-19, affecting approximately 25% of patients. While most headaches resolve within weeks, some persist for months, suggesting underlying structural brain changes. This study aimed to identify brain MRI abnormalities associated with chronic headaches in patients with a history of COVID-19 infection.

Methods: This retrospective study included 30 patients with post-COVID-19 headaches and 30 control patients with no history of COVID-19. Demographic characteristics were analyzed using t-tests and chi-square tests. MRI findings were categorized into six types: cortical atrophy, white matter lesions, vascular lesions, lacunar lesions, vascular encephalopathy, and sinusitis. Differences in MRI findings between the two groups were evaluated using chi-square tests. Secondary outcomes included the analysis of symptoms accompanying headaches, diagnoses following MRI, and treatments applied.

Results: White matter lesions were significantly more frequent in the post-COVID-19 group (50%) compared to controls (20%) (p = 0.015). Conversely, sinusitis was more prevalent in the control group (36.7%) than in the post-COVID-19 group (6.7%) (p = 0.005). Other MRI abnormalities showed no significant differences. Cognitive dysfunction (30%) and dizziness (33.3%) were the most common associated symptoms. The most frequent diagnoses after MRI in the post-COVID-19 group were headaches/migraines (23.3%), post-COVID-19 headache (20%), and vestibular syndrome (13.3%).

Conclusions: Persistent post-COVID-19 headaches may be linked to structural white matter changes observed in MRI. Further research, ideally including pre-infection imaging data, is needed to determine the causal relationship between these lesions and chronic headache symptoms.

Trial registration: This study was registered in ClinicalTrials with the trial registration number NCT06825741 on 13 February 2025.

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covid -19后头痛患者的脑结构异常

背景/目的：头痛是与COVID-19相关的最常见神经系统症状之一，影响约25%的患者。虽然大多数头痛会在几周内消退，但有些会持续数月，这表明大脑存在潜在的结构性变化。本研究旨在确定有COVID-19感染史的患者与慢性头痛相关的脑MRI异常。方法：回顾性研究30例新冠肺炎后头痛患者和30例无新冠肺炎病史的对照患者。统计学特征分析采用t检验和卡方检验。MRI表现分为皮质萎缩、白质病变、血管病变、腔隙病变、血管性脑病和鼻窦炎6种类型。采用卡方检验评估两组间MRI表现的差异。次要结局包括头痛症状分析、MRI诊断和应用治疗。结果：covid -19后组白质病变发生率（50%）明显高于对照组（20%）（p = 0.015）。相反，对照组的鼻窦炎患病率（36.7%）高于covid -19后组（6.7%）（p = 0.005）。其他MRI异常无明显差异。认知功能障碍（30%）和头晕（33.3%）是最常见的相关症状。在covid -19后组中，MRI后最常见的诊断是头痛/偏头痛（23.3%）、covid -19后头痛（20%）和前庭综合征（13.3%）。结论：持续的covid -19后头痛可能与MRI观察到的白质结构改变有关。需要进一步的研究，最好包括感染前成像数据，以确定这些病变与慢性头痛症状之间的因果关系。试验注册：本研究于2025年2月13日在ClinicalTrials注册，试验注册号为NCT06825741。

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