Risks Associated with COVID-19 Infection and Vaccination for Headache Disorders

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In: COVID-19

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CHSG respects and affirms each individual’s right to self-determination, particularly when choosing cluster headache treatment options. To assist patients in making informed treatment decisions, we are committed to providing scientifically accurate, relevant information on all issues related to cluster headache and other trigeminal autonomic cephalalgias. To that end, we strongly support further study of the Sars-CoV-2 virus and the disease it causes, COVID-19, in large-scale, well-designed, double-blind, placebo-controlled clinical trials. The evidence thus far appears to indicate that patients diagnosed with pre-existing headache disorders are at increased risk of serious and dangerous symptoms that can negatively impact individuals for months. Therefore, it is our position that vaccination (although not without risks) is a safe, effective strategy (for most people) to combat this pandemic.

 

Vaccine Safety

Very little is known about the effect of any COVID-19 vaccine on cluster headache. What little research we have has been done on migraine and tension-type headache. We don’t have answers to all the questions. That doesn’t mean we don’t know anything.

Headache disorder = HIGH Risk for COVID-19 Complications

  • People with headache disorders with an active COVID-19 infection are at increased risk of developing neurological symptoms such as loss of taste and smell, “COVID headache,” and worsening of underlying headache disorder1,12
  • The headache associated with COVID-19 is unique. Patients typically describe it as severe, resistant to treatment, with migraine-like characteristics. Headache specialists identify this headache symptom as a secondary headache disorder, Headache attributed to systemic viral infection.3,6
  • “COVID headache” often lasts for many weeks after the patient has recovered. It can persist for up to 6 months and is one feature of “long COVID.”2
  • Sars-CoV-2 has been detected in the cerebrospinal fluid of infected patients.11
  • Sars-CoV-2 has been found in the brain tissue during post-mortem autopsies of patients who died from COVID-19.
  • The working theory is that the virus crosses the blood-brain barrier via the trigeminal pathways, aided by ACE2 enzymes and CGRP when it lodges in the nasal mucosa.8

Vaccine-related headache symptoms

  • Headache is the most commonly reported side effect of ANY vaccine, not just those for COVID-19.
  • The “headache” side effect is usually accompanied by a low-grade fever, goes away often without treatment, and is best characterized as a tension-type headache.4
  • People with pre-existing headache disorders are more likely to experience this side effect with any vaccine.5,10

A cross-sectional study was conducted involving 172 individuals who experienced headache due to COVID-19 infection.7

  • 52.9% had a diffuse headache
  • median intensity was 7/10
  • median frequency was 7 days per week
  • 52.9% had a pre-existing headache disorder
    • more frequent headache
    • more severe intensity

 

Scientific References:

  1. Bolay H, Özge A, et al. Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities? Headache 2020; 60:2508-2521. doi: 10.1111/head.13998.
  2. Caronna E, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Toward a better understanding of persistent headache after mild COVID-19: Three migraine-like yet distinct scenarios. Headache 2021; 61:1277–1280. doi: 10.1111/head.14197.
  3. Caronna E, Ballvé A, et al. Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia 2020, Vol. 40(13) 1410-1421. 1 September 2020. DOI: 10.1177/0333102420965157.
  4. Ekizoglu E, Gezegen H, et al. The characteristics of COVID-19 vaccine-related headache: Clues gathered from the healthcare personnel in the pandemic. Cephalalgia 5 August 2021. 0 (0) 1-10. DOI: 10.1177/03331024211042390.
  5. Gelfand AA, Poland G. Migraine treatment and COVID-19 vaccines: No cause for concern Headache 2021; 61:409-411. doi: 10.1111/head.14086.
  6. López JT, García-Azorín D, et al. Phenotypic characterization of acute headache attributed to SARS-CoV-2: An ICHD-3 validation study on 106 hospitalized patients. Cephalalgia 2020, Vol 40(13) 1432-1442. 31 August 2020. DOI: 10.1177/0333102420965146.
  1. Magdy R, Hussein M, et al. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia 2020. Vo. 40(13) 1422-1431. doi: 10.1177/0333102420965140.
  2. Messlinger K, Neuhuber W, and May, A. Activation of the trigeminal system as a likely target of SARS-CoV-2 may contribute to anosmia in COVID-19. Cephalalgia 12 July 2021. 0 (0) 1-5. DOI: 10.1177/03331024211036665.
  3. Rocha-Filho PAS and Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia 2020, Vol 40(13) 1443-1451. 27 September 2020. DOI: 10.1177/0333102420966770.
  4. Sekiuchi K, Watanabe N, et al. Incidence of headache after COVID-19 vaccination in patients with history of headache: A cross-sectional study. Cephalalgia 20 July 2021. 0 (0) 1-7. DOI: 10.1177/03331024211038654.
  5. Seth V and Kushwaha S. Residents and Fellows: Headache Rounds Headache Due to COVID-19: A Disabling Combination. Headache 2020; 60:2618-2621. doi: 10.1111/head.14006.
  6. Tolebeyan A, Zhang N, et al. Headache in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Narrative Review. Headache 2020; 69:2131-2138. DOI: 10.1111/head.13980.