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


  • Lénia Silva Serviço de Neurologia / Centro Hospitalar Universitário de Santo António, Porto, Portugal
  • Adriana Lopes Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Ana Pontes Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Ana Gonçalves Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Arlinda Chiteculo Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Beatriz Soares Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Inês Teixeira Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Maria Gonçalves Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Maria Alves Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Maria Cardia Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Mariana Monteiro Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Raquel Eiras Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Sara Costa Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
  • Inês Laranjinha Serviço de Neurologia / Centro Hospitalar Universitário de Santo António, Porto, Portugal
  • Carlos Andrade Serviço de Neurologia / Centro Hospitalar Universitário de Santo António, Porto, Portugal
  • Denis Gabriel Serviço de Neurologia / Centro Hospitalar Universitário de Santo António, Porto, Portugal



COVID-19, Vaccines COVID-19, Migraine Disorders


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.


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Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211. doi: 10.1177/0333102417738202.

Lantéri-Minet M, Radat F, Chautard MH, Lucas C. Anxiety and depression associated with migraine: Influence on migraine subjects’ disability and quality of life, and acute migraine management. Pain. 2005;118319–26.

Sevillano-García MD, Manso-Calderón R, Cacabelos-Pérez P. Comorbilidad en la migraña: depresión, ansiedad, estrés y trastornos del sueño. Rev Neurol. 2007;45:400-5.

Ma M, Fang J, Li C, Bao J, Zhang Y, Chen N, et al. The status and high risk factors of severe psychological distress in migraine patients during nCOV-2019 outbreak in Southwest China: a cross-sectional study. J Headache Pain. 2020;21:100. doi: 10.1186/s10194-020-01168-5.

Holsteen KK, Hittle M, Barad M, Nelson LM. Development and internal validation of a multivariable prediction model for individual episodic migraine attacks based on daily trigger exposures. Headache. 2020;60:2364-79. doi: 10.1111/head.13960.

Moon HJ, Seo JG, Park SP. Perceived stress in patients with migraine: a case-control study. J Headache Pain. 2017;18:73. doi: 10.1186/s10194-017-0780-8.

Suzuki K, Takeshima T, Igarashi H, Imai N, Danno D, Yamamoto T, et al. Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study. J Headache Pain. 2021;22:53. doi: 10.1186/s10194-021-01263-1.

Gentile E, Delussi M, Abagnale C, Caponnetto V, de Cesaris F, Frattale I, et al. Migraine during COVID-19: Data from Second Wave Pandemic in an Italian Cohort. Brain Sci. 2021;11:482. doi: 10.3390/brainsci11040482.

Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP, et al. Evaluation of the Impact of the COVID-19 Lockdown in the Clinical Course of Migraine. Pain Med. 2021;22:2079–91. doi: 10.1093/pm/pnaa449.

Verhagen IE, van Casteren DS, de Vries Lentsch S, Terwindt GM. Effect of lockdown during COVID-19 on migraine: A longitudinal cohort study. Cephalalgia. 2021;41:865–70. doi: 10.1177/0333102420981739.

Membrilla JA, Lorenzo Í, Sastre M, Díaz de Terán J. Headache as a Cardinal Symptom of Coronavirus Disease 2019: A Cross-Sectional Study. Headache. 2020;60:2176-91. doi: 10.1111/head.13967.

Parodi IC, Poeta MG, Assini A, Schirinzi E, del Sette P. Impact of quarantine due to COVID infection on migraine: a survey in Genova, Italy. Neurol Sci. 2020;41:2025-7. doi: 10.1007/s10072-020-04543-x.

Silvestro M, Tessitore A, Tedeschi G, Russo A. Migraine in the Time of COVID-19. Headache. 2020;60:988-9. doi: 10.1111/head.13803.

Schiano di Cola F, Caratozzolo S, di Cesare M, Liberini P, Rao R, Padovani A. Migraine Monitoring in the Time of COVID-19: Triggers and Protectors During a Pandemic. Pain Med. 2021;22:2728–38. doi: 10.1093/pm/pnab202.

Souza DD, Shivde S, Awatare P, Avati A, John SK, Badachi S, et al. Headaches associated with acute SARS-CoV-2 infection: A prospective cross-sectional study. SAGE Open Med. 2021;9:205031212110502. doi: 10.1177/20503121211050227.

Sampaio Rocha-Filho PA. Headache associated with COVID-19: Epidemiology, characteristics, pathophysiology, and management. Headache. 2022;62:650–6. doi: 10.1111/head.14319.

Salamanna F, Veronesi F, Martini L, Landini MP, Fini M. Post-COVID-19 syndrome: the persistent symptoms at the post-viral stage of the disease. a systematic review of the current data. Front Med. 2021;8:653516. doi: 10.3389/fmed.2021.653516.

Ferreira PL, Luzeiro I, Lopes M, Jorge A, Silva B, Ferreira L. Validity and reliability of the Portuguese version of the modified Migraine Disability Assessment. BMC Neurol. 2021;21:58. doi: 10.1186/s12883-021-02085-z.

Gomes AA, Marques DR, Meiavia AM, Cunha F, Clemente V. Psychometric properties and accuracy of the European Portuguese version of the Pittsburgh Sleep Quality Index in clinical and non-clinical samples. Sleep Biol Rhythms. 2018;16:413–22.

Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12:225–37.

Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2022;62:111-2. doi: 10.1111/head.14245.

Bendtsen L, Sacco S, Ashina M, Mitsikostas D, Ahmed F, Pozo-Rosich P, et al. Guideline on the use of onabotulinum-toxinA in chronic migraine: a consensus statement from the European Headache Federation. J Headache Pain. 2018;19:91. doi: 10.1186/s10194-018-0921-8.

Sacco S, Braschinsky M, Ducros A, Lampl C, Little P, van den Brink AM, et al. European headache federation consensus on the definition of resistant and refractory migraine. J Headache Pain. 2020;21:76. doi: 10.1186/s10194-020-01130-5.

Bermejo PE, Dorado R. Zonisamide for Migraine Prophylaxis in Patients Refractory to Topiramate. Clin Neuropharmacol. 2009;32:103–6. doi: 10.1097/WNF.0B013E318170577F.

Al-Hashel JY, Ismail II. Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a webbased survey study. J Headache Pain. 2020;21:115. doi: 10.1186/s10194-020-01183-6.

Delussi M, Gentile E, Coppola G, Prudenzano AMP, Rainero I, Sances G, et al. Investigating the Effects of COVID-19 Quarantine in Migraine: An Observational Cross-Sectional Study From the Italian National Headache Registry (RICe). Front Neurol. 2020;11:597881. doi: 10.3389/fneur.2020.597881.

Fernández-de-las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, et al. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia. 2021;41:1332–41. doi: 10.1177/03331024211020404.

Garcia-Azorin D, Layos-Romero A, Porta-Etessam J, Membrilla JA, Caronna E, Gonzalez-Martinez A, et al. Post-COVID-19 persistent headache: A multicentric 9-months follow-up study of 905 patients. Cephalalgia. 2022;42:804–9. doi: 10.1177/03331024211068074.

Uygun Ö, Ertas M, Ekizoglu E, Bolay H, Özge A, Kocasoy Orhan E, et al. Headache characteristics in COVID-19 pandemic-a survey study. J Headache Pain. 2020;21:121. doi: 10.1186/s10194-020-01188-1.

Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology. 2018;129:343–66. doi: 10.1097/ALN.0000000000002130.

Magdy R, Hussein M, Ragaie C, Abdel-Hamid HM, Khallaf A, Rizk HI, et al. Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study. Cephalalgia. 2020;40:1422–31. doi: 10.1177/0333102420965140.

Cho SJ, Chu MK. Risk factors of chronic daily headache or chronic migraine. Curr Pain Headache Rep. 2015;19:465. doi: 10.1007/s11916-014-0465-9.

Brennan KC, Charles A. Sleep and headache. Semin Neurol. 2009;29:406–18. doi: 10.1055/s-0029-1237113.

Alimoradi Z, Broström A, Tsang HWH, Griffiths MD, Haghayegh S, Ohayon MM, et al. Sleep problems during COVID-19 pandemic and its’ association to psychological distress: A systematic review and meta-analysis. EClinicalMedicine. 2021 Jun;36:100916. doi: 10.1016/j.eclinm.2021.100916.

Kaur RJ, Dutta S, Bhardwaj P, Charan J, Dhingra S, Mitra P, et al. Adverse Events Reported From COVID-19 Vaccine Trials: A Systematic Review. Indian J Clin Biochem. 2021;36:427-39. doi: 10.1007/s12291-021-00968-z.

Sekiguchi K, Watanabe N, Miyazaki N, Ishizuchi K, Iba C, Tagashira Y, et al. Incidence of headache after COVID-19 vaccination in patients with history of headache: A cross-sectional study. Cephalalgia. 2022;42:266–72. doi: 10.1177/03331024211038654.

Ekizoglu E, Gezegen H, Yalınay Dikmen P, Orhan EK, Ertaş M, Baykan B. The characteristics of COVID-19 vaccine-related headache: Clues gathered from the healthcare personnel in the pandemic. Cephalalgia. 2022;42:366–75. doi: 10.1177/03331024211042390.

Castaldo M, Waliszewska-Prosół M, Koutsokera M, Robotti M, Straburzynski M, Apostolakopoulou L, et al. Headache onset after vaccination against SARS-CoV-2: a systematic literature review and meta-analysis. J Headache Pain. 2022;23:41. doi: 10.1186/s10194-022-01400-4.

Silvestro M, Tessitore A, Orologio I, Sozio P, Napolitano G, Siciliano M, et al. Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine. J Clin Med. 2021;10:5914. doi: 10.3390/jcm10245914.

Göbel CH, Heinze A, Karstedt S, Morscheck M, Tashiro L, Cirkel A, et al. Clinical characteristics of headache after vaccination against COVID-19 (coronavirus SARS-CoV-2) with the BNT162b2 mRNA vaccine: a multicentre observational cohort study. Brain Commun. 2021;3:fcab169. doi: 10.1093/braincomms/fcab169. Erratum in: Brain Commun. 2021;3:fcab195.




How to Cite

Silva L, Lopes A, Pontes A, Gonçalves A, Chiteculo A, Soares B, et al. Impact of SARS-CoV-2 Infection and Vaccination on Migraine Symptoms during the COVID-19 Pandemic. Sinapse [Internet]. 2024 Apr. 2 [cited 2024 May 18];24(1):12-2. Available from:



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