Clinical characteristics and factors associated with headaches following COVID-19 vaccination: a cross-sectional cohort study
Melika Jameie1, Mansoureh Togha2, Mehdi Azizmohammad Looha3, Nima Hemmati4, Elham Jafari2, Somayeh Nasergivehchi2, Zeinab Ghorbani5, Zhale Salami2
1Iranian Center of Neurological Research, Neuroscience Institute, Tehran Universoty of Medical Sciences, Tehran, Iran, 2Headache department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran Universoty of Medical Sciences, Tehran, Iran, 3Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran., 4Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, Iran, 5Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Objective:

Describe the coronavirus disease of 2019 (COVID-19) vaccine-related headache characteristics. Determine factors associated with developing headaches and factors related to prolonged headaches (≥ 48h) among COVID-19 vaccine receivers. 

Background:

Vaccines are the safest tools for preventing COVID-19-related morbidity/mortality. Headaches are among the most reported neurological symptoms after vaccination.

Design/Methods:

A retrospective, web-based, population-based cross-sectional cohort study between April 2021 - March 2022 at an academic hospital affiliated with Tehran University of Medical Sciences.

Results:

Of 1822 individuals (mean age: 34.49 ± 11.09, female: 71.5%), 1822, 1122, and 203 received 1st, 2nd, and 3rd dose. Sinopharm, AstraZeneca, and Sputnik-V were the most injected vaccines. We found a headache prevalence of 21.7% - 36.5% following vaccination. More than half of those with post-vaccination headaches reported a previous history of headaches, of whom nearly 38% - 67% reported similar post-vaccination headaches to primary headaches. More than 65% of patients reported similarities between their headaches following COVID-19 infection and COVID-19 vaccination. Following vaccination, most of the patients reported bilateral pressing headaches with moderate intensity, affecting the entire head or multiple head/neck regions. The median duration of initiating headaches following vaccination was 8.0 – 10.0 hours, with a median attack duration of 2.0 – 3.0 hours. Headaches lasted for a median of 12.0 – 48.0 hours. Although a history of primary headaches and post-COVID-19 headaches increased the odds of post-vaccination headaches, they reduced the odds of prolonged post-vaccination headaches. Compared to inactivated vaccines, vector ones increased the odds of both occurrence and prolonged post-vaccination headache. Other factors associated with increased odds of post-vaccination headaches were headaches following previous vaccine doses and post-vaccination fever. 

Conclusions:

The headache prevalence following vaccination was 21.7% - 36.5%. History of primary headache, post-COVID-19 headache, headaches following previous vaccine doses, vector vaccines, and post-vaccine fever increased the odds of post-vaccination headache.  

10.1212/WNL.0000000000203743