Q&A: COVID-19 Vaccine & Migraine Treatment

 
Questions About the COVID-19 Vaccines for People Living with Migraine and COVID-19 vaccine two vaccines against COVID-19 by Pfizer and Moderna have been approved. Several more are in development and may get approval in 2021. These vaccines have the potential to end the pandemic if enough people receive both injections of either one. We will try to address some of these frequently asked questions using the information currently available.

Can I get COVID-19 from the vaccine?

Absolutely not! It is important to understand that the COVID-19 vaccines do not contain any live virus. These vaccines contain a harmless material (RNA) from the virus that instructs some cells in our bodies to make copies of a virus protein. Our bodies recognize that the protein does not belong there and form antibodies and immune cells against it. Our body develops a defense mechanism to fight the virus that causes COVID-19 if we are infected in the future. We live in a pandemic, and until enough people get immunity through vaccinations, this health emergency will not end.

Many people develop flu-like symptoms after receiving the vaccine. Since I have frequent headaches, should I avoid getting vaccinated?

You might develop side effects from the vaccine, which is normal. These symptoms reflect the body’s initial immune response to the vaccine. These symptoms are mild and temporary, usually lasting hours up to one to two days. Typical side effects include pain at the injection site, tiredness, headache, muscle and joint pain, fever, and chills. Headache occurred in about 60% of people getting the Moderna vaccine and 38% of those receiving the Pfizer vaccine. It is not recommended you take over the counter (OTC) medications like acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), (ibuprofen, naproxen, diclofenac, flurbiprofen) or those that combine acetaminophen or aspirin with butalbital and caffeine (Fioricet®, Fiorinal®) may also reduce the effectiveness of the vaccine or aspirin before or within 24 hours after receiving the vaccine. These medications may reduce the immune response to the vaccine—your provider for advice regarding the use of over-the-counter medications. 

 I heard that the second dose of the vaccine causes more severe side effects than the first. If I get a headache from the first dose, should I skip or delay getting the second dose? Both the Pfizer and Moderna vaccine requires two doses to achieve optimal immunity and protection against COVID-19 infection. The Pfizer vaccine should be repeated in 21 days, and the Moderna vaccine repeated one month after the first dose. If you receive only one dose or delay the second dose past the recommended schedule, you will not be fully protected. Remember, the headache, even slightly worse than the first vaccine, is short-lasting and mild. The headaches and other vaccine side effects may make you uncomfortable for a few days. But it is a small price to pay considering that COVID-19 can be deadly or lead to long-term disability.

I have been injecting a CGRP monoclonal antibody (Aimovig®, Emgality®, Ajovy) to prevent migraine attacks. Will the vaccine block these medications from working, or can these medications prevent the vaccine from protecting me against COVID-19?

In the vaccine clinical trials, participants could not receive other vaccines within two weeks before receiving the COVID vaccine. However, the use of the CGRP monoclonal antibody treatments was not specifically excluded. Some scientists propose a risk that the immune response to the vaccine could lessen the CGRP antibody's effects. Currently, there is no direct evidence. Patients and their providers should discuss the timing of CGRP injections before and after vaccination. 

I have been getting Botox® injections as a treatment for my chronic migraine. Do I need to avoid or delay getting the vaccine?

Some headache specialists and movement disorder specialists who administer Botox® for various neurological diseases have speculated that the vaccine could make Botox® less effective. However, there is no direct evidence for this. Patients and their healthcare providers should discuss the timing of Botox® injections if the injections are due two weeks before or after vaccination. 

The vaccines may offer a way out of the COVID-19 pandemic.  It can only happen if enough of us get vaccinated to make a difference. Remember to socially distance, wear a mask and continue with frequent hand washing.