COVID Vaccination and Infection linked to worsening of migraine pain

Preliminary data from a recent study suggest that COVID-19 vaccination or SARS-CoV-2 infection may have a limited impact on migraine worsening. This study was published in the European Journal Of Neurology. While some patients reported experiencing worsening migraines after either vaccination or infection, detailed headache diaries did not show significant differences in migraine frequency. This suggests that the role of vaccination or infection in exacerbating migraines may be minimal.

The study, led by Dr. Patricia Pozo-Rosich and her colleagues at Vall d'Hebron Hospital in Barcelona, Spain, aimed to investigate the potential link between COVID-19-related events and migraine worsening. About half of individuals with SARS-CoV-2 infection experience headaches, and COVID-19 vaccines have also been associated with mild to moderate head pain.

The researchers noted that migraine patients often report anxiety and concerns about COVID-19 and vaccination, worrying that these events might trigger or worsen their migraines. While there have been anecdotal reports of migraine worsening following COVID-19 infection or vaccination, systematic data on this topic have been lacking.

To gather information, the researchers conducted an online survey in May 2022, targeting adult migraine patients at an outpatient headache clinic in Spain. The survey aimed to collect data on SARS-CoV-2 infection and vaccination, specifically asking participants if they had noticed any worsening of their migraines after these events. The survey also assessed the participants' level of concern regarding migraine worsening.

• A total of 550 patients completed the survey, with a majority being women (86%) and an average age of 46.5 years.
  
• Nearly 61% of participants met the classification criteria for chronic migraine.
• The survey revealed that 24.7% of respondents reported migraine worsening after SARS-CoV-2 infection, while 11.4% reported worsening after vaccination.
• One of the factors associated with perceived migraine worsening was a concern about migraine deterioration, with odds ratios of 2.5 for infection and 17.3 for vaccination.

To further investigate, electronic diary data were available for 52 individuals with SARS-CoV-2 infection and 54 who had been vaccinated. Analysis of this data showed no significant difference in the number of monthly headache days or migraine days one month before and after infection or vaccination. This was consistent regardless of whether patients reported migraine worsening or not.

The researchers emphasised that while headache is a common symptom of COVID-19, it may not necessarily be linked to an increase in migraine frequency. They concluded that clinicians should provide patients with a more reassuring message, indicating that COVID-19 and COVID-19 vaccines are likely to have only a marginal impact on migraine course. Individual factors related to migraine attacks may have a more significant influence.

While this study provides valuable insights, the researchers cautioned that the findings should be interpreted with caution due to small sample sizes and the potential influence of unmeasured confounders and recall bias. Additionally, the use of one-month timepoints for headache diaries may not capture the full course of migraine changes accurately. Nevertheless, this study contributes to a better understanding of the relationship between COVID-19 events and migraine outcomes.

The researchers concluded that clinicians should provide patients with a more reassuring message, indicating that COVID-19 and COVID-19 vaccines are likely to have only a marginal impact on migraine. Individual factors related to migraine attacks may have a more significant influence. However, the researchers cautioned that the findings should be interpreted with caution due to small sample sizes and potential biases. Further research is needed to confirm these preliminary findings.

Reference:

Melgarejo, L., Caronna, E., Rosell-Mirmi, J., Elosua-Bayés, I., Alpuente, A., Torres-Ferrus, M., Gallardo, V. J., & Pozo-Rosich, P. Migraine worsening after COVID‐19 and COVID‐19 vaccination: Are we facing a nocebo effect? European Journal of Neurology: The Official Journal of the European Federation of Neurological Societies,2023. https://doi.org/10.1111/ene.16058