Impact of SARS-CoV-2 Infection and Vaccination on Migraine Symptoms during the COVID-19 Pandemic

Introduction: Studies have shown the worsening of migraine associated with the COVID-19 infection and the pandemic more broadly. COVID-19 vaccination has also been associated with symptomatic headache, with high frequency among migraineurs. We aimed to assess the impact of COVID-19 diagnosis and vaccine administration on migraine, during the SARS-CoV-2 pandemic. Methods: An online questionnaire was sent to migraine patients followed in a neurology outpatient clinic between March and November 2022. The survey inquired about migraine symptoms and treatment changes, as well as sleep changes, anxiety, and depressive symptoms during the pandemic, after a COVID-19 diagnosis and/or vaccination. Results: Out of the 185 patients included, 108 (58.4%) reported a change in headache pattern (intensity, frequency, and/or pain quality) and 47% reported higher intensity and frequency. The pattern changes occurred before the COVID-19 diagnosis in 41%. Of all the participants with headache changes 72.2% needed to intensify medication (abortive or prophylaxis), regardless of infection status. High levels of insomnia, anxiety, and depressive symptoms were found among patients with worsening migraine, irrespective of COVID-19 diagnosis. After vaccination, 49 (27.1%) described a change in headache pattern, with a worsening pattern in 29 (16%). In half, this change occurred for up to 3 weeks. Conclusion: Worsening of migraine was more likely associated with other factors related to the pandemic rather than COVID-19 diagnosis. COVID-19 vaccination might have acted as an additional but less relevant and temporary trigger for migraine worsening.