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Meta-Analysis
. 2022 Sep;62(8):1019-1028.
doi: 10.1111/head.14376. Epub 2022 Sep 2.

The relationship of headache as a symptom to COVID-19 survival: A systematic review and meta-analysis of survival of 43,169 inpatients with COVID-19

Víctor J Gallardo  1 , Robert E Shapiro  2 , Edoardo Caronna  1   3 , Patricia Pozo-Rosich  1   3
Affiliations
Meta-Analysis

The relationship of headache as a symptom to COVID-19 survival: A systematic review and meta-analysis of survival of 43,169 inpatients with COVID-19

Víctor J Gallardo et al. Headache. 2022 Sep.

Abstract

Objective: To study the relationship between coronavirus disease 2019 (COVID-19) mortality and headache among patients evaluated for COVID-19 in Emergency Departments and hospitals.

Background: COVID-19 has disparate impacts on those who contract it. Headache, a COVID-19 symptom, has been associated with positive disease prognosis. We sought to determine whether headache is associated with relative risk of COVID-19 survival.

Methods: A systematic search in PubMed was performed independently by three reviewers to identify all COVID-19 clinical inpatient series in accordance with the PRISMA guideline. Studies were included if the study design, COVID-19 confirmation method, disease survival ratio, and presence of headache symptom were accessible. We included 48 cohort studies with a total of 43,169 inpatients with COVID-19: 81.4% survived (35,132/43,169) versus 18.6% non-survived (8037/43,169). A meta-analysis of the included studies was then performed. The study was registered on PROSPERO (ID: CRD42021260151).

Results: When considering headache as a symptom of COVID-19, we observed a significantly higher survival rate (risk ratio: 1.90 [1.46, 2.47], p < 0.0001) among COVID-19 inpatients with headache compared to those without headache.

Conclusion: Headache among patients with COVID-19 presenting to hospitals may be a marker of host processes which enhance COVID-19 survival. Future studies should further confirm these findings, in order to better understand this relation and to try to address possible limitations related to the inclusion of more severe patients who would be unable to report symptoms (e.g., patients who were intubated).

Keywords: coronavirus disease 2019; headache; meta-analysis; mortality.

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Conflict of interest statement

Dr. Shapiro has received, in the past 12 months, financial or editorial compensation as a research consultant for Eli Lilly and Lundbeck. Mr. Gallardo reports no disclosures. Dr. Caronna has received honoraria from Novartis, Chiesi, Lundbeck, and Medscape. Dr. Pozo‐Rosich has received honoraria as a consultant and speaker for Allergan‐AbbVie, Biohaven, Chiesi, Eli Lilly, Lundbeck, Medscape, Novartis, and Teva. Her research group has received research grants from Novartis; has received funding for clinical trials from Alder, Amgen, electroCore, Eli Lilly, Lundbeck, Novartis, and Teva. She is the Honorary Secretary of the International Headache Society. She is on the editorial board of Revista de Neurologia. She is an editor for Cephalalgia, Headache, Neurologia, and Frontiers of Neurology, and an advisor for The Journal of Headache and Pain. She is a member of the Clinical Trials Guidelines Committee of the International Headache Society. She has edited the Guidelines for the Diagnosis and Treatment of Headache of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org. Dr. Pozo‐Rosich does not own stocks from any pharmaceutical company. There are no conflicts of interest in regard to this manuscript.

Figures

FIGURE 1
FIGURE 1
The PRISMA flow diagram of the meta‐analysis. We excluded 2719 studies after abstract evaluation for any of the following reasons: (1) original article was not accessible; (2) main outcome of the study was disease severity but not mortality; (3) total proportions of survivors/non‐survivors among hospitalized patients were not available; or (4) the number of patients with headache symptom was not reported adequately in any group (survivors or non‐survivors).
FIGURE 2
FIGURE 2
(A) Pooled prevalence of symptoms and signs among inpatients with COVID‐19. (B) Relative risk of survival for inpatients with COVID‐19 relative to their symptoms, signs and comorbid diseases. CI, confidence interval; RR, relative risk factors.
FIGURE 3
FIGURE 3
Risk of COVID‐19 inpatient survival associated with the presence of headache symptom. CI, confidence interval; RR, relative risk factors.
See this image and copyright information in PMC

Comment in

  • Virtual issue: COVID-19 and headache.
    Caronna E, Pozo-Rosich P. Caronna E, et al. Headache. 2023 Feb;63(2):183-184. doi: 10.1111/head.14464. Epub 2023 Jan 12. Headache. 2023. PMID: 36633206 No abstract available.

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