COVID19 and Headache: A Primer for Trainees.

Abstract

To summarize for the trainee audience the possible mechanisms of headache in patients with COVID19 as well as to outline the impact of the pandemic on patients with headache disorders and headache medicine in clinical practice.COVID19 is a global pandemic caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2, of which a large subset of patients features neurological symptoms, commonly headache. The virus is highly contagious and is, therefore, changing clinical practice by forcing the limitations of in-person visits and procedural treatments, more quickly shifting toward the widespread adaptation of telemedicine services.We review what is currently known about the pathophysiology of COVID19 and how it relates to possible mechanisms of headache, including indirect, potential direct, and secondary causes. Alternative options for the treatment of patients with headache disorders and the use of telemedicine are also explored.Limited information exists regarding the mechanisms and timing of headache in patients with COVID19, though causes relate to plausible direct viral invasion of the nervous system as well as the cytokine release syndrome. Though headache care in the COVID19 era requires alterations, the improved preventive treatment options now available and evidence for feasibility and safety of telemedicine well positions clinicians to take care of such patients, especially in the COVID19 epicenter of New York City.