Case report: atypical migraine as a sentinel symptom for SARS-COV2 infection

Pucci, Ennio; Falvo, Marco Quintilio; Nava, Valentina; Lagorio, Marta

Background and aims: Migraine without aura is the most frequent of the forms of migraines (about 60% - 80% of all forms of migraines). There are many causes that can trigger migraines, including infections (IHS ICDH-3). Methods: 69 year old woman. Professional nurse. Family history of migraine (maternal line). Arising in school age. Diagnosis made according to the IHS ICDH-3 criteria. The patient presented 2–3 crises / month with pulsating pain in the bilateral frontotemporal region, medium-strong intensity, associated with photo-phonophobia, nausea, sometimes vomiting. Duration 24–36 h. Triggering factors: menstruation and psychophysical stress. After menopause (49 years) reduction of intensity, duration and frequency with 1–2 cris / month related stress lasting 12–24 h and responsive to NSAID intake. No preventive therapy performed. Results: On 29.11.2020 episode of atypical headache (described as different from other episodes) with very strong, throbbing, stabbing, burning pain in the bilateral front-temporal region, unresponsive to the intake of NSAIDs. Duration 24 h. No other symptoms reported, apiretic. 30.11.2020: TNF fast: +. Molecular TNF: positive for SARS COV 2. During the period of infection headache present whenever the patient had fever and was unresponsive to paracetamol. Conclusions: In our case report, atypical migraine can be considered a sentinel symptom of an initial infection. The patient works as a professional nurse in the ward which had become Covid on 3.11.2020.