Covid-19 and headaches

It is hard to think or write about anything other than Covid-19, so here is some information on Covid-19 and headaches.

The bad news is that the long-suffering headache patients are suffering more. Most hospitals consider Botox injections, nerve blocks, and other procedures to treat headaches as “nonessential”. Yes, our patients will not die like some of those with Covid-19, but a more nuanced approach than just canceling all “nonessential” procedures should’ve been possible. My NYC colleagues are not needed to treat Covid-19 patients and they are just sitting around worrying about their patients and their own futures. We are a private headache clinic and are continuing to see patients in our office (with all the precautions) for Botox and other procedures, although the number of patients we are treating has dropped by three quarters. Most are understandably concerned about contracting the virus and are staying home.

As far as the relationship between Covid-19 and headaches, it appears that this virus can sometimes invade the brain. This is not surprising because many viruses that affect the respiratory system can also affect the brain. The brain symptoms of Covid-19 are similar to those seen with other brain infections, including headaches (at times with nausea and vomiting), seizures, and disturbed consciousness. Loss of sense of smell is very characteristic of Covid-19 and it happens because of the damage to olfactory nerves. These nerve endings line the nasal cavity and they are directly connected to cell bodies of neurons in the brain. This is one of the possible routes of entry of the virus into the brain.

Recent reports suggest that Covid-19 causes blood clotting in small blood vessels of the lungs, which may be contributing to deaths in some patients. A few cases of strokes in Covid-19 patients have been reported, although it is not clear if blood clotting or even the virus itself were responsible. The Mt. Sinai Hospital system to which I belong just issued guidance for the use of blood thinners in Covid-19 patients. This could be life-saving for some critically ill people.

All this may sounds very alarming, but fortunately, most neurological and other symptoms of Covid-19 resolve in over 99% of patients. The mortality rate of Covid-19 seems higher than 2% only because there are so many people who had the infection with mild or no symptoms and those people are not included in the calculations of mortality rates.

One silver lining is that now we all practice telemedicine. The technology has existed for years, but a major obstacle has been the unwillingness of insurance companies to pay for telemedicine visits. The telehealth parity law was actually passed in NYS in 2016. This pandemic will make televisits much more commonplace. Telehealth law excludes audio-only and electronic messaging-only. Fortunately, there are several HIPAA-compliant video platforms that make televisits easy to conduct. Less than half of our patients need to be in the office for a procedure while the rest can be safely and effectively treated remotely. Most people have busy lives and not having to trudge to the office will save them hours of time.