Those neurologists who specialize in headaches have certainly received phone calls or visits from their patients that after infection with the pandemic virus OR after their vaccination they have experienced a worsening of their headache and/or migraine. So we will have to see how the data is so far.
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Does virus infection make headache/migraine worse?
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The answer is YES. A survey in JAMA Neurology of patient records shows that "headache" was the most common self-reported symptom. A total of 38% reported it, 44% of women and 49% of patients younger than 40 years of age. And we also know that patients who had a pre-existing neurological condition (such as migraine) were more susceptible. That's what the evidence says. As for how long this deterioration lasts, I will have to quote the personal experience from my patients, because there is not enough evidence in the international literature: usually it is 1-2 weeks, but there are also patients who report deterioration for 1 month, maybe a little more .
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Do SARS-CoV-2 vaccines make migraine worse?
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Here the answer can again be empirical, because there is no literature data at least at the moment. It is generally true that VACCINES ARE THE ONLY SOLUTION TO ADDRESS THE PANDEMIC. They are very effective and have no significant side effects. Migraine patients who have had the Astra Zeneca vaccine report worsening pain in the days following the vaccination. This worsening is usually for a few days to 1-2 weeks. Treatment of post-vaccine migraine would probably be preferable with triptans. No migraine patient who has had any of the other vaccines has reported an aggravation to me.
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What do we do with our migraine preventative if we get the virus? What do we do with preventive treatment after vaccination?
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In both cases: WE CONTINUE with our treatment as normal. Only 2 (two) cases of cranial swelling in a patient with chronic migraine who were vaccinated with Moderna's vaccine and treated with botox type A (BOTOX) after a few days have been recorded by the FDA. The swelling was at the injection sites and subsided in a few days. Regarding patients receiving monoclonal antibodies for migraine prevention, although CGRP receptors are also present on cells of the immune system, monoclonal antibodies do NOT affect immune function and thus these patients can also be vaccinated. Just if they do the monoclonal antibody in the upper extremity, let them do it in the opposite arm that they did the vaccine for that month. So again we conclude: we normally do our post-vaccination migraine treatment!
