"Abstract
Methods: This retrospective cohort study included 732 migraine patients who had AstraZeneca Vaxzevria, Pfizer-BioNTech Comirnaty, or Moderna Spikevax vaccines. Participants provided information through questionnaires and headache diaries. Headache frequency before and after vaccination and factors associated with headache risk were examined.
Results: Approximately a third of patients reported increased headache the day after having primary and booster doses, with mean increase ± SD of 1.9 ± 1.2 and 1.8 ± 1.1 days/week, respectively... Headache proportion increased after having all three boosters (Vaxzevria 27.1% vs. 17.9% p = 0.003; Comirnaty 34.1% vs. 24.5% p = 0.009; Spikevax 35.2% vs. 24.8% p = 0.031)... For booster dose, headache risk generally increased on the vaccination day, peaked on the day after vaccination, and subsided gradually with fluctuating pattern within a month. Our study also showed that headache increased on the day before primary dose but not booster dose vaccination and it may be attributable to stress associated with having to undertake new vaccines. Multivariable analyses showed that depression was associated with headache.
Conclusion: Prolonged headache with vaccine- and dose-specific headache pattern was found. Patients with higher risks of vaccine-related headache must be informed of the potential worsening headache.
Introduction
... In patients with migraine, headache associated with vaccinations against SARS-CoV-2 was higher in pain intensity and less responsive to usually effective painkillers. Studies suggested potential mechanism and trigger for vaccine-related headache included vaccine-induced activation and production of inflammatory mediators which may also play critical roles in migraine occurrence or worsening, and anxiety or stress associated with having to undertake vaccination...
Discussion
... Interestingly, higher concentrations of innate immunity cytokines were also detected after booster dose of vaccine injection, which parallel the higher proportion of headache after booster dose of vaccine users reported here (proportion with increased headache days: 35.1% after booster dose >29.6% after primary dose) and by published studies. Besides, studies suggested vaccine-induced spike protein may bind to angiotensin-converting enzyme 2 (ACE2) which disrupt the normal cleavage of angiotensin (Ang) II, downregulating ACE2/Ang 1-7 pathway and leaving pathogenic Ang II/AT1R actions unopposed, which may result in increased sympathetic activity, blood pressure, oxidative stress, inflammation, nociception activity and subsequent headache. Higher serum Ang II was shown to be associated with increased circulating levels of calcitonin gene-related peptide, which may explain the observed higher headache frequency in migraine patients when compared with non-headache or less severe counterparts."
© International Headache Society 2023.
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