从过去到现在并面向未来：一种机制导向的COVID-19相关头痛与病毒后疼痛临床框架

文献信息

中文摘要

头痛是COVID-19突出的急性和持续性神经系统表现，既是重要的临床挑战，也是理解SARS-CoV-2嗜神经效应的宝贵模型。本综述综合证据表明，COVID-19头痛的流行病学明显受较年轻年龄、女性性别和既往头痛障碍病史的影响；其临床表型多样，与嗅觉缺失等化学感觉功能障碍密切相关；其核心病理生理涉及神经炎症（例如细胞因子介导的通路）、三叉血管激活以及性别特异性神经内分泌-免疫相互作用。尽管急性头痛通常对常规镇痛药有反应，但持续性病例——COVID-19急性后遗症（PASC）的主要组成部分——需要多学科管理方法。这与疫苗接种后通常自限性的头痛形成对比。未来研究应优先开展纵向研究以界定慢性化、对性别特异性通路进行机制研究，并开发表型特异性、个体化治疗策略。

英文摘要

Headache is a prominent acute and persistent neurological manifestation of COVID-19, representing both as a significant clinical challenge and a valuable model for understanding the neurotropic effects of SARS-CoV-2. This review synthesizes evidence showing that the epidemiology of COVID-19 headache is distinctly shaped by younger age, female sex, and a prior history of headache disorders; its clinical phenotypes are diverse, strongly associating with chemosensory dysfunctions such as anosmia; and its core pathophysiology involves neuroinflammation (e.g., cytokine-mediated pathways), trigeminovascular activation, and sex-specific neuroendocrine-immune interactions. Although acute headache often responds to conventional analgesics, persistent cases-a major component of Post-Acute Sequelae of COVID-19 (PASC)-necessitate a multidisciplinary management approach. This contrasts with the typically self-limiting headache following vaccination. Future research should prioritize longitudinal studies to define chronicity, mechanistic investigations into sex-specific pathways, and the development of phenotype-specific, personalized therapeutic strategies.