TRANSCRIPT:

Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

This episode is brought to you in part by our generous sponsors Amgen and Novartis.

Molly O’Brien: Hey, everyone. I’m Molly O’Brien, and welcome to Spotlight on Migraine. I’m so excited to chat about our topic today. We’re talking all about the COVID-19 vaccines and migraine. To help us sort through all this, I’d like to introduce our guest. She’s a board-certified neurologist and director of the Westport Headache Institute, Dr. Deena Kuruvilla. 

Dr. Kuruvilla, thank you so much for joining us today.

Dr. Deena Kuruvilla: Thank you so much for having me, Molly.

Molly: We’re super excited to have you and also would like to say that Dr. Kuruvilla is also an AMD executive board member. 

OK, so we’re going to jump into this topic, and I just want to clarify for our viewers, followers, listeners that we’re talking specifically about the COVID-19 vaccines and migraine. We’re not going to dive into COVID-19 itself. That would be a lot to handle. 

All right, so, Dr. Kuruvilla, can you just give us some background information? There are two vaccines approved for use in the United States, the Pfizer vaccine and the Moderna vaccine. Can you just tell us a little bit about what these vaccines are and what they’re made of?

Dr. Kuruvilla: Absolutely. So, at the moment, it’s an exciting time because we have two FDA-approved vaccinations against COVID-19: the Moderna-produced vaccine and the Pfizer-produced vaccine. Both of these vaccines were released in December of 2020 for emergency use within the United States. In many of the states, the first phase has been rolled out and now a lot of the general population is receiving it.

Vaccinations are basically meant to teach your body about a specific virus. Viruses are made up of RNA and DNA, and they have a protective coat of protein. With the Moderna and Pfizer vaccines, the protective coat of protein is the spike protein. And so the spike protein is produced by messenger RNA. Both of these vaccines are messenger-RNA vaccines and basically are using that spike protein to teach your body how to fight the virus if you were exposed to the virus or the virus enters the body.

Molly: It’s so fascinating to learn about this, and the science is absolutely incredible because they were developed so quickly. So it’s pretty excited on that front.

Dr. Kuruvilla: Absolutely.

Molly: Can you tell us a little bit about the two vaccines, how they are — you told us how they’re similar — maybe a little bit about how they’re different and some other similarities that they have between them?

Dr. Kuruvilla: Absolutely. The vaccines work very similarly because they work through that same process using messenger RNA to expose the body to that spike protein, the proteins that are on the outside of our layer of DNA or RNA. The way that they differ is with the actual splicing or arrangement of the actual RNA molecule. That is the big difference between these two vaccinations.

Otherwise, based on the data, they have very comparable efficacy, they have a very comparable side-effect profile, and both of them are offered in two shots. The Pfizer vaccine is two shots, 21 days apart, and the Moderna vaccine is two shots, 28 days apart. So there’s some small, subtle nuances between the two, but overall, efficacy is very comparable between the two.

Molly: That’s incredible that we have these two vaccines that are so similar, and very exciting, once again. So you mentioned side effects, can you tell us a little bit about what we know of the reported side effects for both of these vaccines?

Dr. Kuruvilla: Oh, absolutely. So the side-effect profiles are very similar for both vaccinations: fevers, chills, muscle pain, myalgias, joint pain. These are the most common side effects, and I’m sure the biggest thing we’ll probably jump in today is headache. So headache is certainly a possible side effect of the vaccinations also. 

The reason for these side effects from the vaccination is our body learning about this virus, learning about the spike protein, and launching an immune response, and so that’s why we see some of these side effects. Side effects are more likely to happen with the second shot of the vaccination than the first shot of the vaccination, but we’re seeing these side effects in both the Pfizer and the Moderna vaccines.

Molly: So now that we have a little bit more background on what the vaccines are, how they’re similar, how they’re a little bit different, can we talk a little bit more about what we know about these vaccines, both the Moderna and the Pfizer vaccine, and their side effect of headache. What do we know?

Dr. Kuruvilla: Absolutely. So headache is one of the reported side effects of both vaccines. We’ve found that around 41 percent of folks who have received the Pfizer vaccine have a headache after the first dose and that number kind of jumps up to 51, 52 percent with the second Pfizer dose. 

So when we compare that to Moderna, around 35 percent of folks who have received the first vaccine have a headache, and that number jumps to over 60 percent with the second dose of Moderna. So headache might be slightly more likely in the Moderna vaccine when compared with the Pfizer vaccine.

The type of headache that we’re seeing is certainly variable for people, but what most people have told me is that it can result in a splitting headache. And I have seen the headache occurring not only in people with a history of headache or a history of migraine, but even in people who have absolutely no history of headache. So it’s very interesting that headache can be a huge part of this picture.

Molly: Yes, it really can be, up to 50 percent in some. That’s incredible. So you talked a little bit about how these side effects come about. Our body is just trying to get used to the protein introduced to us. Is that kind of what explains the headache, or do we know why these vaccines can trigger a headache in some?

Dr. Kuruvilla: Yeah, that’s a great question, Molly. We certainly need more research to be done. Interestingly, I have been personally trying to make this connection between the vaccine and headache, and I’ve written some articles about headache after COVID-19 itself and the kind of neurological picture that we see after COVID-19. And one thing, one key factor that I see in common is cytokines. 

So we know that with COVID-19 itself, there is a cytokine storm that happens, this inflammatory storm that happens. With the coronavirus vaccines, we know that an immune response is kind of elicited when we’re given the vaccine, and as a result, cytokines can also be activated in that scenario. And we know that in conditions such as migraine, cytokines play a huge role in the cause of migraine. 

So I am thinking that the inflammation, the immune response that’s elicited with the vaccinations is what ends up causing the headache associated with it, but I think there needs to be a lot more research before we put a pin on that and say that’s the cause. This is just a similar connection that I’ve seen myself.

Molly: Well, thank you for digging into that for us. That’s fascinating. And, obviously, like you said, more research is needed, but it almost sounds kind of like a perfect storm to trigger, especially for people who have migraine.

Dr. Kuruvilla: Absolutely, absolutely.

Molly: Can you tell us a little bit more about the headache that people experience, what you know, like maybe how long it lasts? You did describe it as a splitting headache, but is this something that could last up to 10 days or is it a few hours? Can you give us a little more info on that?

Dr. Kuruvilla: Of course. It’s really interesting. I think it was back in 2015 or 2016, one of my colleagues put out a report specifically about headache after vaccinations in general. Prior to the COVID-19 vaccinations, the flu vaccine and one of the hepatitis vaccines were the most likely to cause headache after the vaccination. And they found in that particular study — they looked at this huge registry of vaccination-related side effects, and they found that 69 percent of people, if they were going to experience a headache with the vaccine, would experience it within the 24 hours after receiving the vaccine.

With that said, with the COVID-19 vaccine, I certainly do see that the vast majority of people are going to get the headache within 24 hours, but I have also seen the case where the headache has gone on for multiple days, up to 72 hours, and in more rare cases, longer than that.

Molly: Well, that’s unfortunate, but I suppose getting vaccinated against a very deadly virus, it’s worth taking the chance on a headache.

Dr. Kuruvilla: Absolutely.

Molly: So now that we know a little bit more about both of the vaccines approved here in the US and their side effects, how they can trigger headache, is there anything out there that someone can do to either prevent or mitigate or kind of minimize the effects of potential side effects like headache from the COVID-19 vaccines?

Dr. Kuruvilla: Absolutely. So I should start off by saying what not to do.

Molly: We like that.

Dr. Kuruvilla: And I have to say, I am probably the worst patient out there, Molly, because I did not follow these rules when I went to get part one and part two. I should have followed them, but I didn’t. Please don’t be me and be a good — follow the rules.

[laughter]

Molly: Fair enough, fair enough.

Dr. Kuruvilla: But the general recommendation is please do not take acetaminophen, Tylenol, or nonsteroidal anti-inflammatories before your vaccine or within 24 hours after taking the vaccine, because it can blunt — it can lessen your immune response. And so I would probably stay away from pretreating if possible. I know that many folks who have a history of headaches, have a history of migraine, a migraine after the vaccine can be debilitating. But one thing that can be done is to speak with your doctor about setting up a plan in case you do experience a headache with the vaccine.

Migraine-specific treatments, migraine-specific rescue medications, such as gepants — ubrogepant, rimegepant; ditans, which is lasmiditan; and our classic triptans have absolutely no problem with the vaccines. And so we should have a multistep plan — sometimes plan A, plan B, plan C — for when you receive your vaccine if you experience a headache.

Molly: That’s so good to know and such great advice, too, to try to set up a plan with your doctor. I know a lot of people out there living with migraine have plans for specific instances. So this is just one more opportunity to create a plan so you’re not hurting down the road in the long run and still able to get a vaccine.

Dr. Kuruvilla: Yes, 100 percent.

Molly: So we just talked a little bit about what not to do, and I think that’s great advice — there’s a lot of news about that, what not to do — and then also if the medications that you take for migraine, if they interfere with the vaccine. So it sounds like that we don’t know of any interference, correct?

Dr. Kuruvilla: That’s correct. So as far as migraine rescue medications go, the medications which are migraine specific, they have no interaction that we know of with the COVID vaccines. Acetaminophen, nonsteroidal anti-inflammatories are not considered migraine-specific medications, and so that’s why I haven’t lumped those in with the migraine-specific treatments. 

It is a different story, though, when we talk about migraine preventives. So one common question that I have received very frequently is regarding Botox and vaccinations and the COVID-19 vaccines. Should I stay on track with my Botox, or should I delay it if I’m receiving the vaccine? And the general consensus right now is that everyone should stay on time with their Botox, should stay on time with their CGRP monoclonal antibody and their other migraine preventive treatments. There’s not enough evidence out there to say that your preventive treatments should be delayed in relation to the COVID-19 vaccine.

There was this warning that had come out from our dermatology colleagues regarding filler and the COVID-19 vaccine. There was a reaction that was seen in three patients who had received facial filler and then had a reaction with the COVID-19 vaccines. But I have to highlight here, Botox is not filler. They’re completely different, and so there’s a lot of confusion coming up from filler and Botox when people think, “Oh, this is all cosmetic. Is there a problem with Botox too?” Completely different. There’s no known contraindication with Botox and the vaccines.

Molly: And that is such great news to hear and hopefully helps clarify things for people who are a little nervous, because, again, there’s a lot of information out there, so thank you for that. As we wrap up, we do have a couple of viewer questions, and I think we already answered some of them. But if you’re up for it, then we’ll give you a couple questions from our followers.

Dr. Kuruvilla: Sure.

Molly: OK, great. So this viewer wants to know, “Can you take a triptan on the day of a vaccine?”

Dr. Kuruvilla: Yes, you can. So there is no contraindication between using any of these seven available triptans with your COVID-19 vaccine. Do I think you should pretreat with it? If you don’t have a headache or you don’t feel the onset of a headache, you probably don’t need to pretreat. But, certainly, if you feel a headache after your COVID-19 vaccine, earlier is better with triptans. Make sure to treat right at the onset of when you feel any twinge of a headache, and repeat it in two hours if you need further relief.

Molly: OK, thank you for that. And our next question from a follower is, “Is there any evidence out there that either the Moderna vaccine or the Pfizer vaccine is better or has less negative side effects for someone who has migraine?”

Dr. Kuruvilla: That is very interesting. So there’s no data. It’s so early in the course of these vaccines that there’s no information out there that says specifically that people with a history of migraine are more likely to have a headache with the COVID-19 vaccines. There’s nothing out there that says that. 

With that said, the Moderna COVID-19 vaccine does have a slightly higher percentage incidence of headache after the second shot. So in the general population, one may be more likely to have a headache with that second shot of the Moderna vaccine. But, at this point in time, I’ve seen headaches with the Pfizer vaccine, with the Moderna vaccine. There’s probably not a lot of utility in picking and choosing. 

The efficacy of both of the vaccines is very similar. Both of them have greater than 90 percent efficacy after the second shot. So both of them have great efficacy based on clinical trials.

Molly: That’s excellent to hear. And I suppose if you’re actually able to get your hands on the vaccine, at that point you probably don’t care too much on which one it is.

Dr. Kuruvilla: Exactly.

Molly: Well, as we wrap up here, Dr. Kuruvilla, is there anything else that you want to share with our followers out there about the COVID-19 vaccines and migraine?

Dr. Kuruvilla: Absolutely. It is imperative to get vaccinated. Vaccinations are one of the major turning points of our history, and we’ve eliminated so many historical diseases with the vaccines. And so when you get your shot, please take your shot and just have a plan in place if a headache or migraine does occur after receiving the vaccine. I would certainly get my shot again if I needed to.

Molly: Wonderful. Thank you for sharing all that information with us.

Dr. Kuruvilla: No, thank you so much for having me, Molly.

Molly: Definitely. Well, thank you so much, Dr. Deena Kuruvilla, for being our guest here today and sharing all of this incredible information on COVID-19 vaccines and migraine. We are very happy to have you.

Dr. Kuruvilla: Thanks for having me, Molly.

Molly: Such a pleasure. And that wraps up this episode of Spotlight on Migraine. I’m your host, Molly O’Brien. Thank you so much for watching, and we’ll see you next time.

[music]

Voice-over: Thank you for tuning in to Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.