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Fragoso. Neuroimmunol Neuroinflammation 2021;8:50-2 Neuroimmunology
DOI: 10.20517/2347-8659.2020.42 and Neuroinflammation

Letter to Editor Open Access

Headache as the onset and main symptom of
COVID-19 infection

Yara D. Fragoso

Department of Post-Graduate Studies, Universidade Metropolitana de Santos, Santos, SP 11045-002, Brazil.
Correspondence to: Prof. Yara D. Fragoso, Department of Post-Graduate Studies, Universidade Metropolitana de Santos,
Avenida Conselheiro Nebias 536, Santos, SP 11045-002, Brazil. E-mail: yara@bsnet.com.br

How to cite this article: Fragoso YD. Headache as the onset and main symptom of COVID-19 infection. Neuroimmunol
Neuroinflammation 2021;8:50-2. http://dx.doi.org/10.20517/2347-8659.2020.42

Received: 28 May 2020 Accepted: 29 May 2020 Fisrt online: 4 Sep 2020 Published: 21 Mar 2021
Science Editor: Athanassios P. Kyritsis Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
This is a case report of a COVID-19 infection in a young male, previously healthy. The infection evolved with
intense headache as the main symptom for 2 weeks. The headache was throbbing, severe, continuous, and
worsened with efforts such as coughing. The patient presented no meningeal signs and neurological examination
was normal. This is the first report of severe headache at the onset and main symptom of COVID-19 infection.

Keywords: Coronavirus, headache, pain, COVID-19

Dear Editor,
The year 2020 started with a pandemic coronavirus infection that is expected to change human behavior
for years to come. The initial cases started in late 2019, and this is the second coronavirus to lead to severe
[1]
acute respiratory syndrome (SARS); thus, it has been named COVID-19 or SARS-CoV-2 . The clinical
manifestations of COVID-19 vary from none to mild, moderate, severe, and rapidly progressive and
fulminant disease. Its main symptoms include fever (up to 98% of cases), dry cough (68%-76%), dyspnea
[2]
(circa 55%), and myalgia or fatigue (35%-44%) . Anosmia, ageusia, and diarrhea are now recognized
[2,3]
as symptoms of the disease. Headache has been reported as affecting 8%-13% of patients . However,
headache has not been described as the most disabling symptom of COVID-19 yet. We would like to report
a case recently seen in our Neurology Unit.

A healthy and athletic Brazilian male aged 29 years, who did not suffer from headaches, gave consent for his
case to be reported. In mid-March 2020, the patient woke up with bitemporal throbbing headache of severe
intensity. He could not tolerate light and noise and presented low fever (37.8 °C). This headache persisted

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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