Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine

Abstract

Vaccines have represented the breakthrough in the fight against COVID-19. Based on reported headache attacks after vaccination in randomized controlled trials, we focused on the effects of COVID-19 vaccine administration on the migraine population, using an online questionnaire published on Italian Facebook groups oriented to headache patients. We collected data about the demographics and clinical parameters of migraine severity, COVID-19 infection, vaccination, and characteristics of headaches following vaccination. Out of 841 migraine patients filling in the questionnaire, 66.47% and 60.15% patients experienced a headache attack (from 1 hour to 7 days) after the first and the second vaccine dose, respectively. The main finding concerns headaches perceived by 57.60% of patients: attacks following vaccination were referred to as more severe (50.62% of patients), long-lasting (52.80% of patients) and hardwearing (49.69% of patients) compared to the usually experienced migraine attacks. This could be related to the production of inflammatory mediators such as type Iβ interferon. Considering the high prevalence of migraine in the general population, awareness of the possibility of headaches worsening following COVID-19 vaccination in these patients may allow both patients and clinicians to face this clinical entity with conscious serenity, and to reduce the waste of resources towards inappropriate health-care.

Impact of SARS-CoV-2 infection and vaccination on migraine symptoms during the COVID-19 pandemic

“…Increased headache duration and pain intensity, as well as increased need to intensify preventive treatment after COVID-19 vaccine administration has also been previously reported in patients with pre-existing primary headache disorders including migraine (36-38). Silvestro M. et al also showed that most patients perceived the headache attacks as "different" from those usually experienced, being characterized by higher pain intensity, longer duration, and reduced responsiveness to usually effective analgesic treatment (39). In our study, headache pattern change was predominantly reported shortly after a vaccine administration, although with much lower frequency than acute symptomatic headache related with COVID-19 or during the pandemic overall.…”

Headache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting

“…In studies of COVID-19 vaccine, migraine-like features were present in one third of the cases (pulsating quality, phonophobia, and photophobia), and in 40-60% of the cases aggravation with activity was observed [68]. Interestingly, in a cohort of individuals with prior diagnosis of migraine, over half perceived the post-vaccination headache attacks as "different" from those usually experienced; this included higher pain intensity, longer duration, and reduced responsiveness to usually effective painkillers [80].…”

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

“…(97) collected data about headache after four different vaccinations (BNT162b2 67.3%, AZD1222 19.5%, mRNA-1273 11.1%, Janssen 2.1%) from 841 patients with migraine. A total of 66.5% of patients reported headache after the first COVID-19 vaccine, and 57.6% reported different features compared to those usually experienced, 52.8% reported a longer duration and 50.6% higher pain intensity (97). Headache during COVID-19 or that following influenza vaccination also showed a significant association with headache following COVID-19 vaccination (ORs = 4.3 and 4.84).…”