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Erschienen in: Acta Neurologica Belgica 2/2022

21.09.2021 | Original article

Indomethacin for refractory COVID or post-COVID headache: a retrospective study

verfasst von: Abouch V. Krymchantowski, Raimundo Pereira Silva-Néto, Carla Jevoux, Ana Gabriela Krymchantowski

Erschienen in: Acta Neurologica Belgica | Ausgabe 2/2022

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Abstract

Background

COVID-19, a disease caused by SARS-CoV-2, manifests with headache, both in the acute phase and as a post-infection symptom, which may be refractory to usual analgesics.

Objectives

Investigate the therapeutic response of refractory COVID or post-COVID headache to indomethacin.

Methods

This was an observational, retrospective, open and uncontrolled. A sample of 37 patients diagnosed with COVID-19 presenting headache during the acute phase or after the resolution of the disease, with refractoriness to the usual symptomatic medication was treated with indomethacin.

Results

Of the 37 patients (24 women and 13 men), 29 were migraineurs and 8 had no previous history of headache. The average age was 40.4 ± 9.4 years, ranging from 19 to 65 years. In 26 (70.3%) patients, the onset of headache occurred within 72 h, and in 11 (29.7%), after 10 days of positivity for Sars-CoV-2. After treatment with indomethacin, 36 patients reported greater than 50% headache relief from the third day and 5 became asymptomatic on the fifth day.

Conclusions

In patients with migraine or no prior history of headache who present with refractory COVID or post-COVID headache to common analgesics, anti-inflammatory drugs, and/or triptans, indomethacin should be considered a therapeutic option.
Literatur
1.
Zurück zum Zitat Shehata GA, Lord KC, Grudzinski MC, Elsayed M, Abdelnaby R, Elshabrawy HA (2021) Neurological complications of COVID-19: underlying mechanisms and management. Int J Mol Sci 22(8):4081CrossRef Shehata GA, Lord KC, Grudzinski MC, Elsayed M, Abdelnaby R, Elshabrawy HA (2021) Neurological complications of COVID-19: underlying mechanisms and management. Int J Mol Sci 22(8):4081CrossRef
2.
Zurück zum Zitat Vehar S, Boushra M, Ntiamoah P, Biehl M (2021) Post-acute sequelae of SARS-CoV-2 infection: caring for the ‘long-haulers.’ Cleve Clin J Med 88:267–272CrossRef Vehar S, Boushra M, Ntiamoah P, Biehl M (2021) Post-acute sequelae of SARS-CoV-2 infection: caring for the ‘long-haulers.’ Cleve Clin J Med 88:267–272CrossRef
3.
Zurück zum Zitat Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bom SD, Rodriguez A et al (2020) Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 277(8):2251–2261CrossRef Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bom SD, Rodriguez A et al (2020) Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 277(8):2251–2261CrossRef
4.
Zurück zum Zitat Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP et al (2020) Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary report of the first 28 patients from the Korean cohort study on COVID-19. J Korean Med Sci 35(13):e142CrossRef Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP et al (2020) Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary report of the first 28 patients from the Korean cohort study on COVID-19. J Korean Med Sci 35(13):e142CrossRef
5.
Zurück zum Zitat Liang WH, Guan WJ, Li CC, Li YM, Liang HR, Zhao Y et al (2020) Clinical characteristics and outcomes of hospitalized patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. Eur Respir J 55(6):2000562CrossRef Liang WH, Guan WJ, Li CC, Li YM, Liang HR, Zhao Y et al (2020) Clinical characteristics and outcomes of hospitalized patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. Eur Respir J 55(6):2000562CrossRef
6.
Zurück zum Zitat Machado FC, Carone Neto G (2021) Carone RSD (2021) Sphenopalatine ganglion block for refractory COVID-19 headache: a descriptive case series. Braz J Anesthesiol S0104–0014(21):00189–00195 Machado FC, Carone Neto G (2021) Carone RSD (2021) Sphenopalatine ganglion block for refractory COVID-19 headache: a descriptive case series. Braz J Anesthesiol S0104–0014(21):00189–00195
7.
Zurück zum Zitat Lucas S (2016) The pharmacology of indomethacin. Headache 56(2):436–446CrossRef Lucas S (2016) The pharmacology of indomethacin. Headache 56(2):436–446CrossRef
8.
Zurück zum Zitat Summ O, Andreou AP, Akerman S, Holland PR, Hoffmann J, Goadsby PJ (2021) Differential actions of indomethacin: clinical relevance in headache. Pain 162(2):591–599CrossRef Summ O, Andreou AP, Akerman S, Holland PR, Hoffmann J, Goadsby PJ (2021) Differential actions of indomethacin: clinical relevance in headache. Pain 162(2):591–599CrossRef
9.
Zurück zum Zitat Akerman S, Karsan N, Bose P, Hoffmann JR, Holland PR, Romero-Reyes M et al (2019) Nitroglycerine triggers triptan-responsive cranial allodynia and trigeminal neuronal hypersensitivity. Brain 142(1):103–119CrossRef Akerman S, Karsan N, Bose P, Hoffmann JR, Holland PR, Romero-Reyes M et al (2019) Nitroglycerine triggers triptan-responsive cranial allodynia and trigeminal neuronal hypersensitivity. Brain 142(1):103–119CrossRef
10.
Zurück zum Zitat Iversen HK, Olesen J (1994) Nitroglycerin-induced headache is not dependent on histamine release: support for a direct nociceptive action of nitric oxide. Cephalalgia 14(6):437–442CrossRef Iversen HK, Olesen J (1994) Nitroglycerin-induced headache is not dependent on histamine release: support for a direct nociceptive action of nitric oxide. Cephalalgia 14(6):437–442CrossRef
11.
Zurück zum Zitat Akerman S, Williamson DJ, Kaube H, Goadsby PJ (2002) The effect of antimigraine compounds on nitric oxide-induced dilation of dural meningeal vessels. Eur J Pharmacol 452(2):223–228CrossRef Akerman S, Williamson DJ, Kaube H, Goadsby PJ (2002) The effect of antimigraine compounds on nitric oxide-induced dilation of dural meningeal vessels. Eur J Pharmacol 452(2):223–228CrossRef
12.
Zurück zum Zitat Summ O, Andreou AP, Akerman S, Goadsby PJ (2010) A potential nitrergic mechanism of action for indomethacin, but not of other COX inhibitors—relevance to indomethacin-sensitive headaches. J Headache Pain 11(6):477–483CrossRef Summ O, Andreou AP, Akerman S, Goadsby PJ (2010) A potential nitrergic mechanism of action for indomethacin, but not of other COX inhibitors—relevance to indomethacin-sensitive headaches. J Headache Pain 11(6):477–483CrossRef
13.
Zurück zum Zitat Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP et al (2021) Evaluation of the impact of the COVID-19 lockdown in the clinical course of migraine. Pain Med 28:449 Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP et al (2021) Evaluation of the impact of the COVID-19 lockdown in the clinical course of migraine. Pain Med 28:449
14.
Zurück zum Zitat Gentile E, Delussi M, Abagnale C, Caponnetto V, De Cesaris F, Frattale I et al (2021) Migraine during COVID-19: data from second wave pandemic in an Italian cohort. Brain Sci 11(4):482CrossRef Gentile E, Delussi M, Abagnale C, Caponnetto V, De Cesaris F, Frattale I et al (2021) Migraine during COVID-19: data from second wave pandemic in an Italian cohort. Brain Sci 11(4):482CrossRef
15.
Zurück zum Zitat Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E et al (2020) Headache characteristics in COVID-19 pandemic – a survey study. J Headache Pain 21(1):121CrossRef Uygun Ö, Ertaş M, Ekizoğlu E, Bolay H, Özge A, Kocasoy Orhan E et al (2020) Headache characteristics in COVID-19 pandemic – a survey study. J Headache Pain 21(1):121CrossRef
16.
Zurück zum Zitat Al-Hashel JY, Ismail II (2020) Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study. J Headache Pain 21(1):115CrossRef Al-Hashel JY, Ismail II (2020) Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study. J Headache Pain 21(1):115CrossRef
17.
Zurück zum Zitat Headache Classification Subcommittee of the International Headache Society (2018) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211 Headache Classification Subcommittee of the International Headache Society (2018) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211
18.
Zurück zum Zitat Harapan H, Michie A, Sasmono RT, Imrie A (2020) Dengue: a minireview. Viruses 12(8):829CrossRef Harapan H, Michie A, Sasmono RT, Imrie A (2020) Dengue: a minireview. Viruses 12(8):829CrossRef
19.
Zurück zum Zitat Harapan H, Michie A, Mudatsir M, Nusa R, Yohan B, Wagner AL et al (2019) Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis. BMC Infect Dis 19(1):243CrossRef Harapan H, Michie A, Mudatsir M, Nusa R, Yohan B, Wagner AL et al (2019) Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis. BMC Infect Dis 19(1):243CrossRef
20.
Zurück zum Zitat Mutiawati E, Syahrul S, Fahriani M, Fajar JK, Mamada SS, Maliga HA et al (2021) Global prevalence and pathogenesis of headache in COVID-19: a systematic review and meta-analysis. F1000Research 9:1316CrossRef Mutiawati E, Syahrul S, Fahriani M, Fajar JK, Mamada SS, Maliga HA et al (2021) Global prevalence and pathogenesis of headache in COVID-19: a systematic review and meta-analysis. F1000Research 9:1316CrossRef
21.
Zurück zum Zitat Zayet S, Kadiane-Oussou NJ, Lepiller Q, Zahra H, Royer PY, Toko L et al (2020) Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect 22(9):481–488CrossRef Zayet S, Kadiane-Oussou NJ, Lepiller Q, Zahra H, Royer PY, Toko L et al (2020) Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect 22(9):481–488CrossRef
22.
Zurück zum Zitat Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G et al (2020) Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci 41(8):2029–2031CrossRef Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G et al (2020) Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci 41(8):2029–2031CrossRef
23.
Zurück zum Zitat Tian S, Chang Z, Wang Y, Wu M, Zhang W, Zhou G et al (2020) Clinical characteristics and reasons for differences in duration from symptom onset to release from quarantine among patients with COVID-19 in Liaocheng. China Front Med (Lausanne) 7:210 Tian S, Chang Z, Wang Y, Wu M, Zhang W, Zhou G et al (2020) Clinical characteristics and reasons for differences in duration from symptom onset to release from quarantine among patients with COVID-19 in Liaocheng. China Front Med (Lausanne) 7:210
24.
Zurück zum Zitat Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J et al (2020) Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: a retrospective, multi-center study. PLoS Negl Trop Dis 14(5):e0008280CrossRef Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J et al (2020) Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: a retrospective, multi-center study. PLoS Negl Trop Dis 14(5):e0008280CrossRef
25.
Zurück zum Zitat Bolay H, Gül A, Baykan B (2020) COVID-19 is a real headache! Headache 60(7):1415–1421CrossRef Bolay H, Gül A, Baykan B (2020) COVID-19 is a real headache! Headache 60(7):1415–1421CrossRef
26.
Zurück zum Zitat Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL et al (2020) Headaches associated with personal protective equipment - a cross-sectional study among frontline healthcare workers during COVID-19. Headache 60(5):864–877CrossRef Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL et al (2020) Headaches associated with personal protective equipment - a cross-sectional study among frontline healthcare workers during COVID-19. Headache 60(5):864–877CrossRef
29.
Zurück zum Zitat Alkotaji M, Al-Zidan RN (2021) Indomethacin: can it counteract bradykinin effects in COVID-19 patients? Curr Pharmacol Rep 22:1–5 Alkotaji M, Al-Zidan RN (2021) Indomethacin: can it counteract bradykinin effects in COVID-19 patients? Curr Pharmacol Rep 22:1–5
31.
Zurück zum Zitat Ho P, Zheng J-Q, Wu C-C, Hou YC, Liu WC, Lu C-L et al (2021) Perspective adjunctive therapies for COVID-19: beyond antiviral therapy. Int J Med Sci 18:314–324CrossRef Ho P, Zheng J-Q, Wu C-C, Hou YC, Liu WC, Lu C-L et al (2021) Perspective adjunctive therapies for COVID-19: beyond antiviral therapy. Int J Med Sci 18:314–324CrossRef
32.
Zurück zum Zitat Amici C, Di Caro A, Ciucci A, Chiappa L, Castilletti C, Martella V et al (2006) Indomethacin has a potent antiviral activity against SARS coronavirus. Antivir Ther 11(8):1021–1030PubMed Amici C, Di Caro A, Ciucci A, Chiappa L, Castilletti C, Martella V et al (2006) Indomethacin has a potent antiviral activity against SARS coronavirus. Antivir Ther 11(8):1021–1030PubMed
Metadaten
Titel
Indomethacin for refractory COVID or post-COVID headache: a retrospective study
verfasst von
Abouch V. Krymchantowski
Raimundo Pereira Silva-Néto
Carla Jevoux
Ana Gabriela Krymchantowski
Publikationsdatum
21.09.2021
Verlag
Springer International Publishing
Erschienen in
Acta Neurologica Belgica / Ausgabe 2/2022
Print ISSN: 0300-9009
Elektronische ISSN: 2240-2993
DOI
https://doi.org/10.1007/s13760-021-01790-3

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