The Kiel Pain Clinic receives hundreds of inquiries every day about a possible connection between a vaccination against Covid-19 and the procedure for parallel migraine treatment. Here are the most important answers:

What do we know about interactions between vaccinations against Covid-19 and simultaneous migraine therapy?

There are currently no results from studies indicating that there are interactions or complications between vaccination against COVID-19 and additional preventive migraine treatment or acute treatment of the migraine attack.

Does this also apply to onabotulinumtoxinA (Botox) injections and CGRP monoclonal antibodies?

This applies to both onabotulinumtoxinA (Botox) injections and the use of CGRP monoclonal antibodies.

Can migraine treatment weaken the vaccine effect?

There is currently no evidence that migraine treatment affects the effectiveness or safety of the COVID-19 vaccines. There is also no evidence that vaccination against Covid-19 reduces the effectiveness of migraine treatment.

There is no data yet to show that the antibodies produced by the vaccine against the SARS-CoV-2 spike protein would render the drug onabotulinumtoxinA ineffective. This also applies to the medications erenumab (Aimovig), fremanezumab (Ajovy) or galcanezumab (Emgality).

Can vaccination and migraine treatment be carried out at the same time without any concerns?

The fact that something is not known or has not yet been investigated does not mean that risks do not exist and that one can proceed without hesitation. This applies in particular to the overlapping of side effects when used at the same time. There are concerns less about effectiveness than about possible overlapping side effects.

What side effects can Covid-19 vaccines have?

Using the BNT162b2 mRNA Covid-19 vaccine (BioNTech/Pfizer) as an example, the most common side effects are injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain ( 38.3%), chills (31.9%), joint pain (23.6%) and fever (14.2%).

Using the ChAdOx1 nCoV-19 (AZD1222) AstraZeneca vaccine as an example, the most common side effects are pain at the injection site (54.2%), headache (52.6%), fatigue (53.1%), muscle pain (44.0%), joint pain (26.4%), and malaise (44.2%), nausea (21.9%), chills (31.9%) or fever > 38 °C (7.9%). In the pivotal clinical trials of the AstraZeneca vaccine, the use of paracetamol before vaccination was recommended as a preventive measure in all trials (except in trial COV005; it was introduced as a change during trial COV001). Vaccinated people were advised to take 1000 mg of paracetamol after vaccination and continue prophylactically at six-hour intervals for 24 hours to reduce adverse reactions caused by the vaccine. It can therefore be assumed that prophylactic administration of paracetamol alleviated side effects such as fever and headache. Preventive treatment of post-vaccination headaches without symptoms is not recommended.

What side effects can monoclonal antibodies have for migraine prevention?

When using monoclonal antibodies to prevent migraines, the following side effects can occur, using erenumab (Aimovig) as an example: hypersensitivity reactions, such as acute strong allergic reactions that affect several or all areas of the body (anaphylaxis), spontaneous (mucous) skin swelling (angioedema) , rash, swelling, water retention (edema), hives (urticaria), constipation, itching (pruritus), immune-related rash with itching, muscle cramps and reactions at the injection site.

Can the overlapping of side effects be reduced?

Since pronounced side effects can occur in individual cases, we recommend keeping as long a gap as possible between the vaccination against Covid-19 and the administration of monoclonal antibodies to prevent migraines in order to avoid additive effects in terms of side effects (summation of side effects of both drugs). Since monoclonal antibodies to prevent migraines are usually administered every four weeks, this corresponds to a possible interval of 14 days. This recommendation is based on avoiding overlapping side effects from both areas of application.

What can you do about headaches after vaccination?

If a headache occurs after the vaccination, it can be treated with aspirin, ibuprofen or paracetamol. Preventive treatment of post-vaccination headaches without symptoms is not recommended.

How to treat migraine attacks after vaccination?

If migraine attacks occur after the vaccination, they can be treated as usual with the recommended acute medication (e.g. triptans, painkillers).