Headache associated with COVID-19 vaccination: how to classify?

Abstract

In the setting of acute COVID-19 infection, headache occurs in 10-60% of patients and may last for days and, in asmaller proportion of patients, weeks (about 10%). However, it is less recognized that headache may also occur after vaccination with ashort latency and may persist for alonger period in astill unclear number of patients. Retrospective description of headache and course in acase series of32 outpatients with headache that changed or recurred after COVID-19 vaccination. The majority of patients experienced an exacerbation of migraine headache; rare headache syndromes such as intracranial hypertension or thunderclap headache occurred in 2patients. Headache manifested in more than 50% of patients within the first 48 h after vaccination. Over 50% of patients who received atriptan improved. The pathophysiological relationship between vaccination and persistent headache is not yet clearly understood. The short latency, partial efficacy of cortisone, and initial findings showing an increase of various inflammatory markers during the course of headache in COVID infection suggest apossible involvement of the innate immune system and here the inflammasome. Furthermore, the response to triptan in aproportion of patients also indicates activation of the trigeminovascular system.