COVID vaccination or SARS-CoV-2 infection may play a small role in migraine worsening, preliminary data suggested.
While some patients reported migraine worsening after either vaccination or infection, headache diaries did not reflect significant differences in migraine frequency, reported Patricia Pozo-Rosich, MD, PhD, of Vall d’Hebron Hospital in Barcelona, Spain, and co-authors.
“Our preliminary data point to a negligible role of the infection and vaccination on migraine worsening and to the possible presence of a nocebo effect in these settings, as a remarkable proportion of patients had a clear perception of migraine worsening,” Pozo-Rosich and colleagues wrote in the European Journal of Neurology.
About half of people with SARS-CoV-2 infection present with headache, and headache can occur during acute or post-acute phases of infection. Studies also have linked COVID vaccines with mild to moderate head pain which can resolve in a few days.
“Not surprisingly, migraine patients often report anxiety and worry about COVID-19 and vaccination, and the possibility of experiencing headache or migraine worsening as a consequence of either of these two events,” Pozo-Rosich and co-authors observed.
“Migraine worsening is frequently reported by patients and it has been postulated that COVID-19 or its vaccines may represent risk factors for a transient or prolonged increase in frequency and chronification of migraine, however, data in this area are lacking,” they added.
In May 2022, Pozo-Rosich and co-authors sent an online survey to adult migraine patients in an outpatient headache clinic in Spain to collect information about SARS-CoV-2 infection and vaccination. They asked patients whether they had noticed worsening of their migraine after infection or vaccination and assessed their level of concern.
A total of 550 patients completed the survey; 86% were women and mean age was 46.5. Nearly 61% fulfilled classification criteria for chronic migraine.
Overall, 247 respondents reported having COVID at least once and 458 respondents said they had been vaccinated. Dates of infection and vaccination were checked against electronic health records. Most infections occurred when Omicron variants were circulating. Of those who were vaccinated, about 80% had an mRNA vaccine.
A quarter of respondents (24.7%) reported migraine worsening after infection and 11.4% after vaccination. Among the risk factors associated with perceived migraine worsening was concern about migraine worsening (OR 2.5 for infection; OR 17.3 for vaccination).
Electronic diary data were available for 52 people with SARS-CoV-2 infection and 54 people who had been vaccinated. The researchers found no significant difference in the number of monthly headache days or migraine days 1 month before and after infection or vaccination. This was consistent when patients with and without self-reported migraine worsening were compared.
“In the case of COVID-19, we reported previously that headache is a frequent and disabling symptom of the infection; however, it may not necessarily be linked to an increase in migraine frequency, when differentiating headache as a secondary symptom and migraine as a disease,” Pozo-Rosich and colleagues wrote.
“In light of our results, we believe that clinicians should deliver to patients a more reassuring message that COVID-19 and COVID-19 vaccines may only marginally affect migraine course and that the impact of the infection and vaccines is probably smaller than that caused by the patient’s individual rhythmicity of migraine attacks,” they added. “This information may help minimize patients’ worry levels and reduce their negative impact on health outcomes.”
The study is the first to compare electronic diary data with patients’ personal impressions of migraine worsening after COVID vaccination or infection, Pozo-Rosich and co-authors said. However, they pointed out, the findings should be interpreted with caution as sample sizes were small.
Unmeasured confounders and recall bias may have influenced results, the researchers acknowledged. The study used 1-month timepoints for headache diaries, and wider time frames may have allowed migraine courses to be better captured.
Pozo-Rosich reported relationships with AbbVie, Amgen, Biohaven, Chiesi, Eli Lilly, Lundbeck, Medscape, Novartis, Pfizer, Teva, Instituto Salud Carlos III, EraNet Neuron, European Regional Development Fund, and the International Headache Society. She is an editor or editorial board member of Revista de Neurologia, Cephalalgia, Headache, Neurologia, Journal of Headache and Pain, and Frontiers of Neurology, a member of the Clinical Trials Guidelines Committee of the International Headache Society, and has edited the headache guidelines of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org.
Co-authors reported relationships with Allergan-AbbVie, Novartis, Chiesi, Lundbeck, Medscape, Teva, Río Hortega grant Acción Estratégica en Salud, Instituto de Salud Carlos III, and Cephalalgia.
European Journal of Neurology
Source Reference: Melgarejo, L, et al “Migraine worsening after COVID-19 and COVID-19 vaccination: Are we facing a nocebo effect?” Eur J Neurol. 2023; DOI: 10.1111/ene.16058.