Although headaches are a well-characterized symptom of coronavirus disease 2019 (COVID-19) infection, limited data exists comparing the clinical course of such hospitalized patients who initially present with headaches to those who do not This retrospective observational study analyzed outcomes of patients aged ≥18 years with laboratory confirmed COVID-19 infection admitted to the Mount Sinai Health System between February 27 and April 19, 2020 Patients presenting with headaches, identified by Natural Language Processing (NLP) analysis of intake notes, were propensity score-matched (5:1) by age, gender, race/ethnicity, comorbidities, and body mass index (BMI) to patients who did not present with headaches Baseline clinical characteristics, admission symptoms, laboratory values collected within 48 hours of admission, and clinical outcomes were compared between the two groups Univariate statistical significance was identified with Kruskal-Wallis one-way ANOVA or chisquared tests at Bonferroni-adjusted P & lt; 0 05 (multiplying P by 66 study-wide tests) During the study period, 191 patients presenting with headaches were admitted and matched to 955 non-headache patients from the same study period Patients were well-matched on age, sex, race/ethnicity, comorbidities, and BMI Patients presenting with headaches had significantly higher rates of GI symptoms upon admission (nausea/vomiting, diarrhea) than non-headache patients (29% vs 18%, P & lt; 0 01), as well as other neurological symptoms (impaired consciousness, dizziness) (17% vs 11%, P = 0 01) Patients with headaches had significantly lower levels of inflammatory markers upon admission, including Creactive protein (P = 0 04), lactate dehydrogenase (P & lt; 0 01), and procalcitonin (P = 0 01) than those without headaches The subset of patients with headaches also had significantly lower white blood cell counts upon admission than patients without headaches (6200 vs 7300, P & lt; 0 01) Patients presenting with headaches had similar levels of mortality, intubation, ICU admission, length of stay, and ventilator usage as patients who did not present with headaches In this propensity score-matched analysis, hospitalized COVID-19 patients with headaches presented more often with concurrent neurological and GI symptoms but had similar levels of in-hospital mortality as patients without headaches