Post-COVID Süreğen Baş Ağrıları: Klinik Özellikleri ve Nörogörüntüleme Bulguları

Öz

Giriş: Bu çalışma, persist­an post-Koronavirüs Hastalığı 2019 (COVID-19) baş ağrısının prevalansını ve klinik özelliklerini incelemiş; ayrıca bu yakınmanın demografik, klinik ve nörogörüntüleme parametreleriyle ilişkilerini gerçek yaşam verilerine dayalı bir hasta kohortu içinde değerlendirmiştir. Böylece, sık bildirilmesine rağmen halen yetersiz anlaşılan bir nörolojik komplikasyon ele alınmıştır. Gereç ve Yöntemler: Polimeraz zincir reaksiyonu (PCR) ile doğrulanmış COVID-19 geçirmiş ve persistan şikâyetlerle nöroloji polikliniğine başvuran toplam 341 hasta değerlendirildi. Hastalar, baş ağrısı varlığına veya yokluğuna göre gruplandı. Demografik özellikler, ek hastalıklar, eşlik eden nörolojik ve sistemik semptomlar ile nörogörüntüleme bulguları (konvansiyonel beyin MRG, difüzyon ağırlıklı görüntüleme [DWI] ve mevcut olduğunda MR venografi) gruplar arasında karşılaştırıldı. İstatistiksel analizlerde ki-kare testi, t-testi veya uygun olduğunda non-parametrik karşılıkları, ayrıca bağımsız ilişkileri belirlemek için lojistik regresyon modelleri kullanıldı. Bulgular: Persistan baş ağrısı hastaların %36,9’unda bildirilmiş olup, daha genç bireylerde ve kadınlarda belirgin şekilde daha sık görülmüştür (ortanca yaş 45’e karşı 55, p < 0,001; kadınlarda %42,9’a karşı erkeklerde %27,5, p = 0,004). Uykusuzluk (p = 0,002), baş dönmesi (p = 0,01) ve miyalji/parestezi (p = 0,03) baş ağrısı olan grupta anlamlı derecede daha yaygındı. Buna karşın difüzyon ağırlıklı görüntüleme (DWI) anormallikleri ve MR venografi patolojileri, baş ağrısı olmayan hastalarda belirgin olarak daha sık saptandı. Anormal MRG bulguları olan hastalarda daha ileri yaş, daha fazla komorbidite ve daha uzun hastane yatışı dikkat çekmekteydi. Çok değişkenli analizde yaş ve kadın cinsiyet, post-COVID baş ağrısının bağımsız belirleyicileri olarak doğrulandı. Sonuç: Post-COVID baş ağrısı, demografik duyarlılık ve eşlik eden disotonomik ya da nöroinflamatuvar semptom kümeleri ile karakterize özgün bir klinik profile sahiptir. Bulgular, post-enfeksiyöz dönemde persistan baş ağrısının altında yatan mekanizmaların daha iyi anlaşılması ve klinik değerlendirmeye daha fazla odaklanılması gerektiğini göstermektedir.

Anahtar Kelimeler

• COVID-19
• Post-Akut COVID-19 Sendromu
• Baş Ağrısı
• Nörolojik Manifestasyonlar

Persistent Headache After COVID-19: Clinical Patterns and Imaging Insights

Öz

Introduction: This study examined the prevalence and clinical characteristics of persistent post-Coronavirus Disease 2019 (COVID-19) headache, and explored its associations with demographic, clinical, and neuroimaging parameters within a real-world patient cohort, thereby addressing a frequently reported yet insufficiently understood neurological complication. Materials and Methods: A total of 341 patients with polymerase chain reaction (PCR)-confirmed COVID-19 who presented with persistent symptoms to a neurology outpatient clinic were evaluated. Patients were grouped according to the presence or absence of an ongoing headache. Demographic characteristics, comorbidities, accompanying neurological and systemic symptoms, and neuroimaging findings (including conventional MRI, diffusion-weighted imaging, and MR venography when available) were compared between the groups. Statistical analyses included chi-squared tests, t-tests or non-parametric equivalents for group comparisons, and logistic regression models to identify independent associations between variables. Results: Persistent headache was reported by 36.9% of patients and was significantly more common among younger individuals and women (median age 45 vs. 55 years, p < 0.001; 42.9% vs. 27.5%, p = 0.004). Insomnia (p = 0.002), dizziness (p = 0.01), and myalgia/paresthesia (p = 0.03) were significantly more common in the headache group. In contrast, abnormal neuroimaging findings, including diffusion-weighted imaging (DWI) abnormalities and MR venography pathology, were significantly more frequent in patients without headaches. Among those with abnormal MRI findings, older age, comorbidity burden, and longer hospitalization duration were observed to be present. Multivariate analysis confirmed age and female sex as independent predictors of post-COVID headache. Conclusion: Post-COVID headache has a distinct clinical profile characterized by demographic susceptibility and concurrent dysautonomic or neuroinflammatory symptom clusters. These findings underline the need for focused clinical evaluation and improved understanding of the mechanisms underlying persistent headache during the post-infectious period.

Anahtar Kelimeler

• COVID-19
• Post-Acute COVID-19 Syndrome
• Headache
• Nervous System Manifestations

Kaynakça

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