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People with migraine had a higher incidence of COVID-19 and heightened COVID symptoms, a cross-sectional study suggested.

They also were less likely to use healthcare resources if they tested positive for COVID, reported Robert Shapiro, MD, PhD, of the University of Vermont in Burlington, in a presentation at the American Headache Society virtual meeting.

"Headache is a prevalent symptom of COVID-19, of long COVID, and of post-vaccination for COVID-19," Shapiro said. "Among COVID-19 inpatients, headache is associated with a positive prognosis."

"IL-6 levels are lower across the disease course," he pointed out. "Headache is associated with 1 week overall. And if someone is admitted with COVID with a symptom of headache, it confers positive relative risk of survival of 2.2."

COVID also is associated with migraine, Shapiro added. "When migraine occurs with COVID-19, it typically begins early in the disease course," he pointed out.

An international study across 171 countries found that was tied to increased COVID-19 mortality rates. Other research has shown that two , SCN1A and IFNAR2, were among 15 host loci associated with changes in COVID-19 outcomes. COVID-19 also has been linked to (CGRP) levels, in contrast to migraine which is associated with elevated CGRP.

These findings raise the question of whether people with migraine have an altered COVID-19 susceptibility, Shapiro observed.

In their study, Shapiro and colleagues looked at a cross-sectional sample of U.S. adults, ages 18 to 65, in the National Health and Wellness Survey (). Responses were fielded from April to July 2020.

Survey respondents were asked whether they ever received a physician diagnosis of migraine, whether they received an influenza vaccine in the past 12 months, whether they self-diagnosed or were tested for COVID-19, and whether they had visited a healthcare provider, emergency department (ED), or had hospital admission in the past 6 months. The researchers estimated healthcare utilization by subtracting rates of people without COVID-19 from rates of people with COVID-19 test positivity.

The study included 66,585 respondents, including 7,759 people with a migraine diagnosis and 58,827 without. Migraineurs had a mean age of 42 and 77% were female. Mean age of people without a migraine diagnosis was 49.6 and 50% were female (all P<0.001).

Overall, 3.82% of migraine patients self-reported having COVID-19 and 1.32% said they had tested positive for COVID. In contrast, 2.42% of the group without migraine self-reported having COVID and 0.82% of that group said they had tested positive (all P<0.001).

Among respondents with COVID-19, those who had migraine reported more and higher percentages of COVID symptoms, Shapiro said.

"However, people with migraine had a relative risk that was lower for utilizing healthcare resources than those in the group that did not have a diagnosis of migraine," he said. "This was true for healthcare provider visits, ED visits, and admission to hospital."

"People with migraine may be more susceptible to COVID-19 or may be more likely to be aware of or may likely to report COVID-19 symptoms -- or a combination of the above," Shapiro noted. They also may be less likely to develop serious COVID, less likely to seek healthcare, or both.

When these new findings are considered together with data showing headache as a positive prognostic indicator for COVID inpatients and links between migraine population prevalence and higher COVID-19 mortality, "a hypothesis emerges that headache as a symptom, and migraine as a disease, may reflect adaptive processes associated with host defenses against viruses," Shapiro suggested.

"For example, migraine-driven behaviors -- such as social distancing due to photophobia, phonophobia, etc. -- in the setting of viral illness may play adaptive roles in reducing viral spread," he said.

The study's limitations included its use of self-reported data from the NHWS.

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