COVID-19 Vaccine and Migraine: What You Must Know

In the effort to protect the population against COVID-19 infection, more than one million doses of the COVID-19 vaccine are being given every day in the United States, and that number continues to climb as production and distribution improve. That means, according to Bloomberg, that more Americans have received their first dose of the vaccine than have tested positive for the virus since the pandemic began in early 2020.

Data so far indicates that the first two vaccines approved in the United States are safe, although the majority of people will experience some type of side effect (or “adverse event”), according to the Centers for Disease Control and Prevention (CDC).

A sample of approximately 2 million people out of the first 22 million Americans to get one of the two COVID-19 vaccines found that about 7 out 10 people reported pain as a result of the vaccine, and 30 percent of people experienced headache as a side effect.

If you have migraine, the headache side effect may have you concerned about what you’ll experience after getting the shot, says Lauren Doyle Strauss, DO, a headache specialist and an assistant professor at Wake Forest Baptist Health in Winston Salem, North Carolina.

“That worry is totally understandable; most people with migraine know that anything that could cause a headache in someone else — a virus, an infection, not getting sleep, too much caffeine, not enough caffeine — is very often a trigger for them that can cause a migraine attack,” says Dr. Strauss.

To help you better understand the risks and benefits of getting the COVID-19 vaccine, here are some expert answers about potential side effects of the vaccine and how you can treat them.

1. COVID-19 Vaccine Side Effects, Including Headache, Are Short-Lived and Self-Limiting

There are currently two authorized vaccines to prevent against infection with COVID-19: the Pfizer-BioNTech COVID-19 vaccine and Moderna’s COVID-19 vaccine. “Both these vaccines are in the same platform, which is the mRNA platform, and the data on these vaccines is quite similar,” says Emad Estemalik, MD, the section head for headache and facial pain at the Center for Neurological Restoration at Cleveland Clinic in Ohio.

“Headache is part of what we call the systemic side effects that occur with the vaccine. Other systemic side effects include fever, fatigue, muscle pain, and joint pain,” says Dr. Estemalik. All these side effects are transient, meaning they last only a short time, he adds.

Side effects of the vaccine usually last anywhere from 24 to 48 hours, and they occur more commonly after the second dose, according to Johns Hopkins Bloomberg School of Public Health. “Younger people tend to have more side effects than older people,” says Estemalik.

That said, none of these side effects should discourage anyone from getting the vaccine, he says. “Experiencing any of these side effects is actually a good indicator that you’re developing a good and rapid immune response to the vaccine. Remember, all the side effects are transient and self-limiting,” he says. Self-limiting describes a condition that will resolve on its own and have no long-term harmful effect on your health.

2. You Should Not Skip or Delay the Second Dose, Even if You Had Side Effects After the First

Even if you had a bad headache after your first dose of the vaccine, you should absolutely not skip or delay the second shot, says Estemalik.

“In simple terms, you could think of the first dose as the primer; the second booster dose is what really elevates the antibody production and drives the high efficacy of the vaccines — 94 percent for the Moderna vaccine and 95 percent for the Pfizer vaccine,” he says.

The Pfizer-BioNTech vaccine doses should be given three weeks apart, and the Moderna vaccine doses four weeks apart, according to the CDC.

3. Experts Advise Against Taking Migraine Drugs or Painkillers Before Getting the Vaccine

There’s a lot of debate, even within the scientific community, about whether a person should take a medication as a preventive measure to ease side effects before getting the vaccine — and particularly about what effect medications could have on the immune response, says Estemalik.

A study published in January 2021 in the Journal of Virology found that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may reduce the production of antibodies and affect the immune response to the virus itself.

The CDC recommends against the use of pain relievers before the vaccine shot.

Estemalik agrees. “In my opinion, people should not premedicate with any medication before taking the vaccine. That would include any migraine treatment or over-the-counter painkillers,” he says.

Strauss suggests making sure you’re fully hydrated before getting the vaccine. This may help not only with any potential headache, but also with dizziness, another possible side effect, she says.

4. Headaches or Migraine Attacks That Occur Following Vaccination Can Be Treated as Usual

After getting the vaccine, if a person has a headache, they can take either their regular migraine abortive drug or an over-the-counter medication to help ease any of the symptoms, says Estemalik.

“There was initial concern that if you took an over-the-counter medication after your vaccine that it might make it less effective, but there isn’t evidence to support that,” says Strauss.

“Since people can manage any headache that may come on as a side effect of the vaccine with their normal medications, I hope that takes a little of the fear away. This headache might last longer than what you’re used to, but you can certainly treat it,” she says.

5. No Special Measures Are Needed if You Use CGRP Antibodies

There are currently four monoclonal antibody medications — Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Vyepti (eptinezumab) — that are used in the prevention of migraine, including three injectables and one infusible, says Estemalik. “There are no contraindications and no concerns for people on these medications in terms of getting the mRNA vaccines,” he says.

People on these medications do not need to stop any of their drugs for a certain period of time before getting their vaccines, says Estemalik.

6. Botox Injections for Migraine Are Safe Before or After COVID-19 Vaccination

There have been reported side effects when it comes to certain cosmetic fillers and the mRNA vaccines, says Estemalik. Some people who have received dermal fillers (usually in the face or lips) may develop swelling at or near the site of filler injection following a dose of the vaccine. This appears to be temporary and can resolve with medical treatment, according to the CDC.  

Dermal fillers are a different kind of medication from Botox, says Estemalik. “This side effect has not been reported in people who have received Botox injections for preventative migraine treatment. It is safe for patients who are getting Botox injections to take the COVID-19 vaccine,” he says.

7. COVID-19 Infection Raises the Risk of Severe or Persistent Headache; Vaccination Does Not

“Headaches that don’t respond to treatment have not been reported as a side effect of the vaccines. The headaches that happen after the vaccine are transient, subsiding within a day or two, and they respond to simple over-the-counter painkillers,” says Estemalik.

After weighing the risks and benefits of the vaccine, experts say the risk of a more severe headache is higher in people who actually get sick with COVID-19, says Strauss.

“We are seeing patients who are experiencing new headache that’s persisting after getting a COVID-19 infection, and we’re also seeing patients with a known history of migraine who really have their headaches exacerbated by a COVID-19 infection,” she says. “Headache aside, COVID-19 carries additional risks to your health and even your life.”

RELATED: A Guide to Living With Migraine During the COVID-19 Pandemic

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