Daily Persistent Headaches in Adolescents Can Be Related to Covid-19

At the University of Kentucky Children and Young Adult Headache Program, recently there has been a surge in cases of New Daily Persistent Headaches (NDPH). A few of these patients had tested positive for COVID-19 prior to persistent headaches and the majority of them remembered some mild viral illness prior to the persistent headache. It is not clear if these recent cases are directly linked to COVID-19 but there is a possibility. Although these headaches cause significant suffering by affecting the quality of life (calculated by PedMIDAS Score), there is no evidence that they may result in permanent damage.

According to the International Classification of Headache Disorders, NDPH is de novo chronic headache that is persistent from its onset and the patient clearly remembers the events around the onset of headache. This type of headache lasts at least three months. This is a unique headache as it is persistent and unremitting from onset. This headache shares different characteristics from other primary headaches like migraine, tension-type headache, etc. Most cases do not have clear etiology, but various viral etiologies have been described in the past. Interestingly, children and young adults have a higher prevalence of NDPH ( 0.1% vs. 0.03%) when compared to adults.

Most adolescents with symptomatic COVID-19 infection experience mild symptoms including a dull headache and, according to major publications and the CDC, 80% of asymptomatic adolescents at the time of a positive test later develop some symptoms within two weeks. We can deduce that previously labelled “asymptomatic cases” are just “pre-symptomatic.”

Like any other headache disorder, correct classification and identification result in a better prognosis. One of the challenges in treating NDPH is to avoid additional medicine overuse which is considered taking any over-the-counter pain medicine more than three times a week for at least three months. A few cases of NDPH might respond to daily preventative medications. Daily preventative medications can be taken every day with good tolerance, unlike as-needed pain medicines.