Headache attributed to SARS-CoV-2 infection, vaccination and the impact on primary headache disorders of the COVID-19 pandemic: A comprehensive review

Abstract

Objective The objective is to summarize the knowledge on the epidemiology, pathophysiology and management of secondary headache attributed to SARS-CoV-2 infection and vaccination; as well as to delineate their impact on primary headache disorders. Methods This is a narrative review of the literature regarding primary and secondary headache disorders in the setting of COVID-19 pandemic. We conducted a literature search in 2022 on PubMed, with the keywords “COVID 19” or “vaccine” and “headache” to assess the appropriateness of all published articles for their inclusion in the review. Results Headache is a common and sometimes difficult-to-treat symptom of both the acute and post-acute phase of SARS-CoV-2 infection. Different pathophysiological mechanisms may be involved, with the trigeminovascular system as a plausible target. Specific evidence-based effective therapeutic options are lacking at present. Headache attributed to SARS-CoV-2 vaccinations is also common, its pathophysiology being unclear. People with primary headache disorders experience headache in the acute phase of COVID-19 and after vaccination more commonly than the general population. Pandemic measures, forcing lifestyle changes, seemed to have had a positive impact on migraine, and changes in headache care (telemedicine) have been effectively introduced. Conclusions The ongoing COVID-19 pandemic is a global challenge, having an impact on the development of secondary headaches, both in people with or without primary headaches. This has created opportunities to better understand and treat headache and to potentiate strategies to manage patients and ensure care.

Effect of COVID vaccination on monthly migraine days: a longitudinal cohort study

“…24 Therefore, it is hypothesized that COVID-19 vaccination may initiate the release of inflammatory mediators, which in turn may trigger migraine headaches. 32 Our study has some limitations. First, the infection analysis was limited by a smaller sample size with less diary days and a low incidence of reported COVID-19 infections among our cohort of subjects with migraine.…”

“…24 Therefore, it is hypothesized that COVID-19 vaccination may initiate the release of inflammatory mediators, which in turn may trigger migraine headaches. 32…”

Long COVID and especially headache syndromes

“…Long COVID headache may activate different mechanisms from those that act in the acute phase of disease, namely persistent CNS inflammation such as unresolved brain or meninges inflammation, neuronal damage, persistent cytokine release and immune activation. It has been hypothesized that mechanisms such as high glutamate levels and N-methyl-D-aspartate (NMDA) receptors upregulation can account for symptoms such as brain fog, light headed and cognitive dysfunction [5,22].…”

“…Headache is a common symptom of COVID-19 and can manifest early in the acute phase of the disease, associated with or without other constitutional symptoms, or can manifest weeks or months after the time of infection [5]. The persistence of long-lasting symptoms after an apparently harmless infection from SARS-CoV-2 is an emerging problem.…”

COVID-19 related headaches: epidemiology, pathophysiology, impacts, and management

“…The possibility of having headaches at the onset of COVID-19 infection is significantly linked with a previous history of migraine [25]. People with preexisting primary headache disorders experience headaches in the acute phase of COVID-19 and after vaccination more commonly than the general population [48]. Individuals with a history of migraine are more likely to present with COVID-19 related headache that has a migraine phenotype [23 ▪ ,24 ▪ ,28].…”