Background & Aims

Persistent sympathetic nervous system activation (PSA – activation of the fight/flight/freeze system) is emerging as a significant contributor to chronic overlapping pain conditions such as migraine headache and chronic post-infectious disorders such as post-acute sequelae of SARS-COV-2 (Long-COVID). We hypothesized that individuals with pre-existing PSA, as evidenced by pre-existing migraine prior to a COVID infection, would have higher rates of Long-COVID symptoms after excluding patients with pre-existing fatigue.

Methods

TriNetX is a global health research network that facilitates deidentified data queries of healthcare records for over 117 million people in the world. We queried TriNetX for subjects with a history of COVID infection, with and without long-COVID (defined as new fatigue symptoms lasting ?1 month post-infection) and compared rates of pre-infection migraine diagnoses present in the 4 years prior to Covid infection in both groups.

We utilized the following codes for Long Covid: ICD 10 codes: UO7.1; UO7.2; J12.82 as well as TNX Curated 9088; LOINC 94500-6 and 94309-2 and the following for “fatigue” 1 month after the infection and without fatigue prior (ICD 10 codes R53 and G93.3).

Results

~4.0 million (3.8%) patients had a COVID infection and 2.9 million (2.7%) had a pre-existing history of migraine. Of the 173,000 patients with Long-COVID (4% of the COVID-infected population), 17,000 (9.8%) had a prior migraine diagnosis, compared to 164,000 (3.9%) of those without long-COVID (Chi-squared p <0.00001). In addition, new onset migraine after Covid infection occurred in 7,651 subjects (4.3%) in the Long Covid group, compared to ~51,000 of those in the short Covid group (1.2%) p<0.00001.

Conclusions

These preliminary findings are consistent with the hypothesis that PSA brought on by a pre-existing migraine diagnosis may increase Long-COVID risk, and may suggest new targets for Long-COVID prevention or treatment. Future studies should more rigorously examine the role of chronic pain and other PSA syndromes (fibromyalgia, chronic fatigue, irritable bowel syndrome, postural tachycardia syndrome) as a predisposing factor in Long-COVID.

References

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Presenting Author

Gisela Chelimsky

Poster Authors

Gisela Chelimsky

Dr. med.

Virginia Commonwealth University

Lead Author

Patrick Shi

Virginia Commonwealth University

Lead Author

Patricia Kinser

Virginia Commonwealth University

Lead Author

James Burch

Virginia Commonwealth University

Lead Author

Raouf Gharbo

DO

Virginia Commonwealth University School of Medicine

Lead Author

Thomas Chelimsky

MD

Lead Author

Topics

  • Epidemiology