Download PDF
Semin Neurol 2023; 43(02): 286-296
DOI: 10.1055/s-0043-1767781
Review Article

A Review of Neurological Symptoms in Long COVID and Clinical Management

Allison Navis
1   Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Long COVID is a clinical diagnosis generally referring to the persistence or development of new symptoms, affecting multiple organ systems after SARS-CoV-2 COVID-19 infection. Long COVID is thought to affect ∼20% of people after infection, including all age ranges and severity of infection. Fatigue, postexertional malaise, and respiratory and cardiac symptoms are commonly described. Neurological symptoms such as cognitive changes, sensory disturbances, headaches, and dysautonomia are common as well. The underlying pathophysiology remains unclear but immune dysregulation, autoimmunity, persistent viral reservoirs, and microvascular dysfunction have been implicated. As there are no tests at this time to diagnose long COVID, work-up should be focused on assessing reversible or treatable causes of symptoms. Furthermore, no treatments for long COVID currently exist, and management remains focused on a multimodal approach and symptom management, with many people showing improvement in symptoms over time.

Keywords

fatigue - brain fog - dysautonomia - headache - neuropathy


Publication History

Article published online:
17 April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 World Health Organization. WHO coronavirus (COVID-19) dashboard. Updated July 12, 2022. Accessed July 13, 2022 at: https://covid19.who.int/
    PubMed
  • 2 Centers for Disease Control and Prevention. Long COVID or post-COVID conditions. Updated July 11, 2022. Accessed July 13, 2022 at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
    PubMed
  • 3 Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2022; 22 (04) e102-e107
    CrossrefPubMedGoogle Scholar
  • 4 Davis HE, Assaf GS, McCorkell L. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 2021; 38: 101019
    CrossrefPubMedGoogle Scholar
  • 5 Cabrera Martimbianco AL, Pacheco RL, Bagattini AM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: a systematic review. Int J Clin Pract 2021; 75 (10) e14357
    CrossrefPubMedGoogle Scholar
  • 6 CDC National Center for Health Statistics. Nearly one in five American adults who have had COVID-19 still have “long COVID.” Updated June 22, 2022. Accessed August 4, 2022 at: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
    PubMed
  • 7 Antonelli M, Pujol JC, Spector TD, Ourselin S, Steves CJ. Risk of long COVID associated with delta versus omicron variants of SARS-CoV-2. Lancet 2022; 399 (10343): 2263-2264
    CrossrefPubMedGoogle Scholar
  • 8 Otto SP, Day T, Arino J. et al. The origins and potential future of SARS-CoV-2 variants of concern in the evolving COVID-19 pandemic. Curr Biol 2021; 31 (14) R918-R929
    CrossrefPubMedGoogle Scholar
  • 9 Graham EL, Clark JR, Orban ZS. et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers”. Ann Clin Transl Neurol 2021; 8 (05) 1073-1085
    CrossrefPubMedGoogle Scholar
  • 10 Moreno-Pérez O, Merino E, Leon-Ramirez JM. et al; COVID19-ALC research group. Post-acute COVID-19 syndrome. Incidence and risk factors: a Mediterranean cohort study. J Infect 2021; 82 (03) 378-383
    CrossrefPubMedGoogle Scholar
  • 11 Sudre CH, Murray B, Varsavsky T. et al. Attributes and predictors of long COVID. Nat Med 2021; 27 (04) 626-631
    CrossrefPubMedGoogle Scholar
  • 12 Huang Y, Pinto MD, Borelli JL. et al. COVID symptoms, symptoms clusters, and predictors for becoming a long-hauler: looking for clarity in the haze of the pandemic.
    PubMedGoogle Scholar
  • 13 Booth A, Reed AB, Ponzo S. et al. Population risk factors for severe disease and mortality in COVID-19: a global systematic review and meta-analysis. PLoS One 2021; 16 (03) e0247461
    CrossrefPubMedGoogle Scholar
  • 14 Li Y, Ashcroft T, Chung A. et al. Risk factors for poor outcomes in hospitalised COVID-19 patients: a systematic review and meta-analysis. J Glob Health 2021; 11: 10001
    CrossrefPubMedGoogle Scholar
  • 15 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397 (10270): 220-232
    CrossrefPubMedGoogle Scholar
  • 16 Maestre-Muñiz MM, Arias Á, Mata-Vázquez E. et al. Long-term outcomes of patients with coronavirus disease 2019 a one year after hospital discharge. J Clin Med 2021; 10 (13) 2945
    CrossrefPubMedGoogle Scholar
  • 17 Needham DM, Davidson J, Cohen H. et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40 (02) 502-509
    CrossrefPubMedGoogle Scholar
  • 18 Rousseau AF, Minguet P, Colson C. et al. Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic. Ann Intensive Care 2021; 11 (01) 118
    CrossrefPubMedGoogle Scholar
  • 19 Zangrillo A, Belletti A, Palumbo D. et al; COVID-BioB Study Group. One-year multidisciplinary follow-up of patients with COVID-19 requiring invasive mechanical ventilation. J Cardiothorac Vasc Anesth 2022; 36 (05) 1354-1363
    CrossrefPubMedGoogle Scholar
  • 20 van Kessel SAM, Olde Hartman TC, Lucassen PLBJ, van Jaarsveld CHM. Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review. Fam Pract 2022; 39 (01) 159-167
    CrossrefPubMedGoogle Scholar
  • 21 Vanichkachorn G, Newcomb R, Cowl CT. et al. Post-COVID-19 syndrome (long haul syndrome): description of a multidisciplinary clinic at Mayo Clinic and characteristics of the initial patient cohort. Mayo Clin Proc 2021; 96 (07) 1782-1791
    CrossrefPubMedGoogle Scholar
  • 22 Sandler CX, Wyller VBB, Moss-Morris R. et al. Long COVID and post-infective fatigue syndrome: a review. Open Forum Infect Dis 2021; 8 (10) ofab440
    CrossrefPubMedGoogle Scholar
  • 23 Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, ; Board on the Health of Select Populations, ; Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: National Academies Press; 2015
    Google Scholar
  • 24 Wong TL, Weitzer DJ. Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)-a systemic review and comparison of clinical presentation and symptomatology. Medicina (Kaunas) 2021; 57 (05) 418
    CrossrefPubMedGoogle Scholar
  • 25 Bateman L, Bested AC, Bonilla HF. et al. Myalgic encephalomyelitis/chronic fatigue syndrome: essentials of diagnosis and management. Mayo Clin Proc 2021; 96 (11) 2861-2878
    CrossrefPubMedGoogle Scholar
  • 26 Michelen M, Manoharan L, Elkheir N. et al. Characterising long COVID: a living systematic review. BMJ Glob Health 2021; 6 (09) e005427
    CrossrefPubMedGoogle Scholar
  • 27 Ceban F, Ling S, Lui LMW. et al. Fatigue and cognitive impairment in post-COVID-19 syndrome: a systematic review and meta-analysis. Brain Behav Immun 2022; 101: 93-135
    CrossrefPubMedGoogle Scholar
  • 28 Becker JH, Lin JJ, Doernberg M. et al. Assessment of cognitive function in patients after COVID-19 infection. JAMA Netw Open 2021; 4 (10) e2130645
    CrossrefPubMedGoogle Scholar
  • 29 Valdes E, Fuchs B, Morrison C. et al. Demographic and social determinants of cognitive dysfunction following hospitalization for COVID-19. J Neurol Sci 2022; 438: 120146
    CrossrefPubMedGoogle Scholar
  • 30 Cristillo V, Pilotto A, Cotti Piccinelli S. et al; Neuro Covid Next Study group. Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment. Aging Clin Exp Res 2022; 34 (01) 257-260
    CrossrefPubMedGoogle Scholar
  • 31 Liu YH, Wang YR, Wang QH. et al. Post-infection cognitive impairments in a cohort of elderly patients with COVID-19. Mol Neurodegener 2021; 16 (01) 48
    CrossrefPubMedGoogle Scholar
  • 32 Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 2021; 8 (05) 416-427
    CrossrefPubMedGoogle Scholar
  • 33 Wang L, Davis PB, Volkow ND, Berger NA, Kaelber DC, Xu R. Association of COVID-19 with new-onset Alzheimer's disease. J Alzheimers Dis 2022; 89 (02) 411-414
    CrossrefPubMedGoogle Scholar
  • 34 Larsen NW, Stiles LE, Miglis MG. Preparing for the long-haul: autonomic complications of COVID-19. Auton Neurosci 2021; 235: 102841
    CrossrefPubMedGoogle Scholar
  • 35 Shouman K, Vanichkachorn G, Cheshire WP. et al. Autonomic dysfunction following COVID-19 infection: an early experience. Clin Auton Res 2021; 31 (03) 385-394
    CrossrefPubMedGoogle Scholar
  • 36 Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11 (01) 14042
    CrossrefPubMedGoogle Scholar
  • 37 Borges do Nascimento IJ, Cacic N, Abdulazeem HM. et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med 2020; 9 (04) 941
    CrossrefPubMedGoogle Scholar
  • 38 Lopez-Leon S, Wegman-Ostrosky T, Perelman C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11 (01) 16144
    CrossrefPubMedGoogle Scholar
  • 39 Diaz-Mitoma F, Vanast WJ, Tyrrell DL. Increased frequency of Epstein-Barr virus excretion in patients with new daily persistent headaches. Lancet 1987; 1 (8530): 411-415
    CrossrefPubMedGoogle Scholar
  • 40 Martelletti P, Bentivegna E, Spuntarelli V, Luciani M. Long-COVID headache. SN Compr Clin Med 2021; 3 (08) 1704-1706
    CrossrefPubMedGoogle Scholar
  • 41 Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, ; Board on the Health of Select Populations; Institute of Medicine. Current case definitions and diagnostic criteria, terminology, and symptom constructs and clusters. In: Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: National Academies Press; 2015
    Google Scholar
  • 42 Silva MTT, Lima MA, Torezani G. et al. Isolated intracranial hypertension associated with COVID-19. Cephalalgia 2020; 40 (13) 1452-1458
    CrossrefPubMedGoogle Scholar
  • 43 Dakay K, Cooper J, Bloomfield J. et al. Cerebral venous sinus thrombosis in COVID-19 infection: a case series and review of the literature. J Stroke Cerebrovasc Dis 2021; 30 (01) 105434
    CrossrefPubMedGoogle Scholar
  • 44 Palaiodimou L, Stefanou MI, Katsanos AH. et al. Cerebral venous sinus thrombosis and thrombotic events after vector-based COVID-19 vaccines: a systematic review and meta-analysis. Neurology 2021; 97 (21) e2136-e2147
    CrossrefPubMedGoogle Scholar
  • 45 Oaklander AL, Mills AJ, Kelley M. et al. Peripheral neuropathy evaluations of patients with prolonged long COVID. Neurol Neuroimmunol Neuroinflamm 2022; 9 (03) e1146
    CrossrefPubMedGoogle Scholar
  • 46 Abrams RMC, Simpson DM, Navis A, Jette N, Zhou L, Shin SC. Small fiber neuropathy associated with SARS-CoV-2 infection. Muscle Nerve 2022; 65 (04) 440-443
    CrossrefPubMedGoogle Scholar
  • 47 Raahimi MM, Kane A, Moore CE, Alareed AW. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of ‘long COVID-19 syndrome’?. BMJ Case Rep 2021; 14 (01) e240178
    CrossrefPubMedGoogle Scholar
  • 48 Premraj L, Kannapadi NV, Briggs J. et al. Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis. J Neurol Sci 2022; 434: 120162
    CrossrefPubMedGoogle Scholar
  • 49 Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun 2020; 89: 531-542
    CrossrefPubMedGoogle Scholar
  • 50 Mazza MG, De Lorenzo R, Conte C. et al; COVID-19 BioB Outpatient Clinic Study group. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun 2020; 89: 594-600
    CrossrefPubMedGoogle Scholar
  • 51 Meng X, Deng Y, Dai Z, Meng Z. COVID-19 and anosmia: a review based on up-to-date knowledge. Am J Otolaryngol 2020; 41 (05) 102581
    CrossrefPubMedGoogle Scholar
  • 52 Hickie I, Davenport T, Wakefield D. et al; Dubbo Infection Outcomes Study Group. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006; 333 (7568): 575
    CrossrefPubMedGoogle Scholar
  • 53 Lam MH, Wing YK, Yu MW. et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med 2009; 169 (22) 2142-2147
    CrossrefPubMedGoogle Scholar
  • 54 Sotzny F, Blanco J, Capelli E. et al; European Network on ME/CFS (EUROMENE). Myalgic encephalomyelitis/chronic fatigue syndrome - evidence for an autoimmune disease. Autoimmun Rev 2018; 17 (06) 601-609
    CrossrefPubMedGoogle Scholar
  • 55 Ryan FJ, Hope CM, Masavuli MG. et al. Long-term perturbation of the peripheral immune system months after SARS-CoV-2 infection. BMC Med 2022; 20 (01) 26
    CrossrefPubMedGoogle Scholar
  • 56 Scherlinger M, Felten R, Gallais F. et al. Refining “long-COVID” by a prospective multimodal evaluation of patients with long-term symptoms attributed to SARS-CoV-2 infection. Infect Dis Ther 2021; 10 (03) 1747-1763
    CrossrefPubMedGoogle Scholar
  • 57 Robinson-Papp J, Astha V, Nmashie A. et al. Sympathetic function and markers of inflammation in well-controlled HIV. Brain Behav Immun Health 2020; 7: 100112
    CrossrefPubMedGoogle Scholar
  • 58 Robinson-Papp J, Nmashie A, Pedowitz E. et al. Vagal dysfunction and small intestinal bacterial overgrowth: novel pathways to chronic inflammation in HIV. AIDS 2018; 32 (09) 1147-1156
    CrossrefPubMedGoogle Scholar
  • 59 Matschke J, Lütgehetmann M, Hagel C. et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol 2020; 19 (11) 919-929
    CrossrefPubMedGoogle Scholar
  • 60 Thakur KT, Miller EH, Glendinning MD. et al. COVID-19 neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital. Brain 2021; 144 (09) 2696-2708
    CrossrefPubMedGoogle Scholar
  • 61 Douaud G, Lee S, Alfaro-Almagro F. et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 2022; 604 (7907): 697-707
    CrossrefPubMedGoogle Scholar
  • 62 Guedj E, Campion JY, Dudouet P. et al. 18F-FDG brain PET hypometabolism in patients with long COVID. Eur J Nucl Med Mol Imaging 2021; 48 (09) 2823-2833
    CrossrefPubMedGoogle Scholar
  • 63 Fogarty H, Townsend L, Morrin H. et al; Irish COVID-19 Vasculopathy Study (iCVS) investigators. Persistent endotheliopathy in the pathogenesis of long COVID syndrome. J Thromb Haemost 2021; 19 (10) 2546-2553
    CrossrefPubMedGoogle Scholar
  • 64 Seeßle J, Waterboer T, Hippchen T. et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis 2022; 74 (07) 1191-1198
    CrossrefPubMedGoogle Scholar
  • 65 Grubb BP. Postural tachycardia syndrome. Circulation 2008; 117 (21) 2814-2817
    CrossrefPubMedGoogle Scholar
  • 66 Basantsova NY, Starshinova AA, Dori A, Zinchenko YS, Yablonskiy PK, Shoenfeld Y. Small-fiber neuropathy definition, diagnosis, and treatment. Neurol Sci 2019; 40 (07) 1343-1350
    CrossrefPubMedGoogle Scholar
  • 67 Ohira M, Sano T, Takao M. Clinical features of patients who visited the outpatient clinic for long COVID in Japan. eNeurologicalSci 2022; 28: 100418
    CrossrefPubMedGoogle Scholar
  • 68 Bungenberg J, Humkamp K, Hohenfeld C. et al. Long COVID-19: objectifying most self-reported neurological symptoms. Ann Clin Transl Neurol 2022; 9 (02) 141-154
    CrossrefPubMedGoogle Scholar
  • 69 Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA 2020; 323 (14) 1389-1400
    CrossrefPubMedGoogle Scholar
  • 70 Mekhael M, Lim CH, El Hajjar AH. et al. Studying the effect of long COVID-19 infection on sleep quality using wearable health devices: observational study. J Med Internet Res 2022; 24 (07) e38000
    CrossrefPubMedGoogle Scholar
  • 71 Balcom EF, Nath A, Power C. Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease. Brain 2021; 144 (12) 3576-3588
    CrossrefPubMedGoogle Scholar
  • 72 WHO. Living Guidance for Clinical Management of COVID-19. Geneva: WHO; 2021
    Google Scholar
  • 73 Nakanishi N, Liu K, Kawakami D. et al. Post-intensive care syndrome and its new challenges in coronavirus disease 2019 (COVID-19) pandemic: a review of recent advances and perspectives. J Clin Med 2021; 10 (17) 3870
    CrossrefPubMedGoogle Scholar
  • 74 Centers for Disease Control and Prevention. Assessment for testing: evaluating and caring for patients with post-COVID conditions, interim guidance. Updated June 14, 2021. Accessed September 17, 2022 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-assessment-testing.html
    PubMed
  • 75 Besnier F, Bérubé B, Malo J. et al. Cardiopulmonary rehabilitation in long-COVID-19 patients with persistent breathlessness and fatigue: the COVID-rehab study. Int J Environ Res Public Health 2022; 19 (07) 4133
    CrossrefPubMedGoogle Scholar
  • 76 Centers for Disease Control and Prevention. Treatment of ME/CFS. Updated January 28, 2021. Accessed September 17, 2022 at: https://www.cdc.gov/me-cfs/treatment/index.html
    PubMed
  • 77 Vance H, Maslach A, Stoneman E. et al. Addressing post-COVID symptoms: a guide for primary care physicians. J Am Board Fam Med 2021; 34 (06) 1229-1242
    CrossrefPubMedGoogle Scholar
  • 78 Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev 2018; 38: 39-49
    CrossrefPubMedGoogle Scholar
  • 79 García A, Angel JD, Borrani J, Ramirez C, Valdez P. Sleep deprivation effects on basic cognitive processes: which components of attention, working memory, and executive functions are more susceptible to the lack of sleep?. Sleep Sci 2021; 14 (02) 107-118
    PubMedGoogle Scholar
  • 80 Ahern E, Semkovska M. Cognitive functioning in the first-episode of major depressive disorder: a systematic review and meta-analysis. Neuropsychology 2017; 31 (01) 52-72
    CrossrefPubMedGoogle Scholar
  • 81 Schreiber M. Treating patients with long COVID. Monit Psychol 2021;52(05). Accessed September 18, 2022 at: https://www.apa.org/monitor/2021/07/treating-long-covid
    PubMedGoogle Scholar
  • 82 Mtinangi BL, Hainsworth R. Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope. Clin Auton Res 1998; 8 (04) 231-235
    CrossrefPubMedGoogle Scholar
  • 83 Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci 2018; 215: 20-27
    CrossrefPubMedGoogle Scholar
  • 84 Sheldon RS, Grubb II BP, Olshansky B. et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015; 12 (06) e41-e63
    CrossrefPubMedGoogle Scholar
  • 85 Winker R, Barth A, Bidmon D. et al. Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension 2005; 45 (03) 391-398
    CrossrefPubMedGoogle Scholar
  • 86 Raj SR, Black BK, Biaggioni I. et al. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. Circulation 2009; 120 (09) 725-734
    CrossrefPubMedGoogle Scholar
  • 87 Raj SR, Black BK, Biaggioni I, Harris PA, Robertson D. Acetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome. Circulation 2005; 111 (21) 2734-2740
    CrossrefPubMedGoogle Scholar
  • 88 Taub PR, Zadourian A, Lo HC, Ormiston CK, Golshan S, Hsu JC. Randomized trial of ivabradine in patients with hyperadrenergic postural orthostatic tachycardia syndrome. J Am Coll Cardiol 2021; 77 (07) 861-871
    CrossrefPubMedGoogle Scholar
  • 89 Finnerup NB, Attal N, Haroutounian S. et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015; 14 (02) 162-173
    CrossrefPubMedGoogle Scholar
  • 90 Robbins MS. Diagnosis and management of headache: a review. JAMA 2021; 325 (18) 1874-1885
    CrossrefPubMedGoogle Scholar
  • 91 AAN Summary of Evidence-based Guidelines for Clinician. Update: Pharmacologic treatment for episodic migraine prevention in adults. American Academy of Neurology and American Headache Society. 2015. Accessed September 18, 2022 at: https://www.aan.com/Guidelines/home/GuidelineDetail/536
    PubMed
  • 92 Yamani N, Olesen J. New daily persistent headache: a systematic review on an enigmatic disorder. J Headache Pain 2019; 20 (01) 80
    CrossrefPubMedGoogle Scholar
  • 93 O'Kelly B, Vidal L, McHugh T, Woo J, Avramovic G, Lambert JS. Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. Brain Behav Immun Health 2022; 24: 100485
    CrossrefPubMedGoogle Scholar