Migraine and Covid-19: What We Know So Far
Migraine and Covid-19: What We Know So Far
The Covid-19 pandemic has taken more than two million lives worldwide, sickened over 100 million,¹ and turned billions of lives upside down in the last year. People with chronic health conditions like migraine disease and other headache disorders have extra worries about risks, treatments, and impacts to our existing conditions. While there’s a lot we don’t know yet, the information emerging about headache and Covid-19 may help you navigate this new healthcare territory.
What’s emerging so far about Covid-19 and migraine:
- Covid-19 vaccines are safe for people who use migraine treatments such as onabotulinumtoxinA and CGRP monoclonal antibodies.
- Headache is a symptom of Covid-19, but it’s different for people with pre-existing migraine disease.
- Covid-19 patients who had headache as a symptom tended to have shorter bouts with Covid-19 illness than patients who didn’t have headache.
- Some “long haul” patients report symptoms months after infection, including migraine-like symptoms.
Covid-19 vaccines are safe to take with migraine treatments
The journal Headache recently asked healthcare professionals and others about advising patients with headache disorders on the Covid-19 vaccine. The answers and advice are in the journal’s recent guest editorial by Dr. Amy Gelfand, U.C. San Francisco, and Dr. Gregory Poland, director of the Mayo Clinic Vaccine Research Group in Minnesota.²
Dr. Poland told a reporter from Medpage Today that migraine preventives like CGRP monoclonal antibodies and onabotulinum toxin A have no reason to interact with the Covid-19 vaccines now available.
“Remember that with monoclonal antibodies, you are giving precision therapy. You’re giving a key that fits into a lock and other keys don’t fit that lock…As far as I can even imagine, none of the CGRP monoclonal antibodies are going to impact the immune response to a COVID vaccine because they’re different biologies and different mechanisms of action and they don’t overlap. The same with onabotulinumtoxinA.”³
There have been discussions about whether people receiving vaccines can take acetaminophen or NSAIDs to treat post-vaccination discomfort and flu-like symptoms. That question becomes more complicated for people with headache disorders who may use those over-the-counter medications to treat attacks. As many people with migraine disease will tell you, any changes in routine can be triggers for migraine attacks—including other illnesses, like the flu. If you’re one of those people who gets a migraine attack when you get sick, before you get a Covid-19 vaccine talk to your healthcare professional about treating any attacks you might get in the 1-3 days following a vaccination.
Headache as Covid-19 symptom: Different for migraine patients
Headache is a common symptom of Covid-19 infection, but the details can be different for people with pre-existing migraine disease.
First, people with migraine disease tend to report headache symptoms that started earlier, lasted longer, and were more intense than people without migraine disease who had Covid-19-related headache. In one study, four out of five Covid-19 patients with pre-existing migraine disease reported attacks lasting longer than one day, compared to only about a third of Covid-19 patients without a previous migraine diagnosis.4
Although headache hasn’t received much clinical attention as a symptom of Covid-19 infection or post-Covid-19 health complications, a headache specialist in Barcelona, Spain wrote about his own case of Covid-19 for the journal Headache.5 Dr. Robert Belvis had not experienced migraine disease himself, but his expertise helped him recognize and document his symptoms in detail. That information may already be helping healthcare professionals advise and treat patients with headache symptoms.
Headache with Covid-19 correlates with shorter clinical course of virus
A study published in Cephalalgia suggests that patients who experience Covid-19-related headache have shorter cases of Covid-19 than patients who don’t experience headache. The study did not find any difference in mortality between those patients with headache and those without.6
Some Covid-19 headaches last longer than the infection
In that same study, a third of patients who had reported headache as a Covid-19 symptom had ongoing headache symptoms six weeks after their Covid-19 experience. Half of those patients still having headache symptoms had not suffered from recurrent headache before Covid-19. 7 Although the headache symptoms varied among those patients still having headache after six weeks, many had symptoms that migraine patients would recognize, like nausea/vomiting, sensitivity to light and sound, and pain that worsened with movement.
Can Covid-19 cause migraine-like attacks in “long haul” patients?
Because we have only a year of experience with Covid-19, it’s difficult to make any firm conclusions, but it looks like the virus may leave some patients with ongoing health challenges past the six-week mark noted in the Cephalalgia study.
These “long haul” patients have a number of symptoms post-infection that they did not have before contracting Covid-19, such as fatigue, cardiac issues, memory and concentration issues, joint pain, and migraine-like symptoms. Social media groups are bringing patients together to compare experiences, and several research projects are underway to help scientists understand long-haul syndromes (like this study, open to all Covid-19 survivors in the US).8
Dr. Anthony Fauci announced in late February 2021 that the National Institutes of Health has been given over a billion dollars to study the “long-haul” phenomenon. Researchers will investigate how “post-acute sequelae of SARS CoV2” or PASC affects some patients and try to develop guidance for preventing and treating PASC. (Sequelae means the conditions or consequences patients may experience as a result of injury or illness.9)
Why do long-haulers who never had migraine disease suddenly have migraine-like attacks? It might have something to do with the body’s inflammatory response. You may have read about the “cytokine storm,” the phenomenon where some people with Covid-19 developed out-of-control immune responses to infection. Researchers suspect that this immune system “storm” might activate the trigeminovascular system, the network of nerves and blood vessels around the trigeminal nerve, the big nerve branch affecting the head and face. We know the virus attacks other parts of the body around that nerve cluster, and we know that neuroinflammation can play a role in migraine disease.10 There might be several mechanisms in that immune system response that could trigger that sensitization, but whatever those mechanisms are, it’s clear that some patients experience problems well after the initial infection is over.
For all that we know so far about headache disorders and Covid-19, there are still important questions we can’t answer yet. Why do some long-haul Covid-19 patients develop headache disorders? How do they respond to treatment? Do people with pre-existing headache disorders experience a change in their symptoms following a Covid-19 infection? Or are they more/less susceptible to other long-haul symptoms?
For now, our best advice is to talk to your own healthcare provider about vaccination, changes in symptoms, and the ways Covid-19 may impact you.