Exploring the impact of acute SARS-CoV-2 infection on headache pattern in patients with migraine: A novel Bayesian analysis.

Objectives: To analyze headache and migraine dynamics around severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Background: Headache is a common symptom of SARS-CoV-2 infection, which caused the coronavirus disease 2019 (COVID-19) pandemic. However, the daily changes in headache patterns in patients with migraine during the infection are unclear.

Methods: This study is a post hoc and retrospective study of patients with migraine and documented COVID-19 diagnoses and headache diaries from a large prospective migraine cohort that consecutively enrolls eligible patients. Patients' characteristics, headache and migraine patterns, and vaccination data were retrieved. Change points in daily headache or migraine rates of this cohort were identified from 28 days before (day -28) to 28 days after (day 28) the infection. We calculated and compared the weekly headache and migraine days of individual patients during pre-infection, infection, and post-infection periods based on the change points. We further categorized patients into those with increased headache days and those without to investigate if vaccinations affected the headache patterns by comparing the pre- and post-infection headache days.

Results: A total of 463 patients, 370 (79.9%) females, with an age (mean ± standard deviation) of 41.5 ± 11.9 years, were enrolled. A total of 26,391 diary days were analyzed. The change-point algorithm identified changes in headache rates on day -4 (95% credible interval: -5.0, -1.2) and day 12 (95% credible interval: 7.6, 17.0). For migraine attacks, the change points were day -2 (95% credible interval: -4.9, -0.8) and day 11 (95% credible interval: 7.6, 17.2). After the grouping based on these change points, we found that the weekly headache days (mean ± standard error of the mean) increased from 1.5 ± 0.1 days during pre-infection to 1.8 ± 0.1 days during acute infection and recovered to 1.6 ± 0.1 days after infection. The weekly migraine days increased from 1.0 ± 0.1 day to 1.3 ± 0.1 days during acute infection and recovered to 1.1 ± 0.1 days. Female patients and those older than 40 had more abrupt changes in headache and migraine patterns. There was no impact of vaccinations on the headache pattern regardless of the type or dose of the vaccinations or the intervals between the last vaccination and the COVID-19 diagnosis.

Conclusion: We demonstrated that the headache and migraine rates among individuals with migraine escalated during the early stage of SARS-CoV-2 infection and returned to baseline along with systemic viral clearance.