Migraine Treatment and COVID-19 Vaccines: No Cause for Concern

Amy A. Gelfand MD; Gregory Poland MD


Headache. 2021;61(3):409-411. 

In This Article

Abstract and Introduction


The advent and availability of coronavirus disease 2019 (COVID-19) vaccines has led patients to pose a number of questions to their headache healthcare providers. In retrospect, it is perhaps surprising that these questions did not come earlier, for example, around annual influenza vaccination campaigns. However, COVID-19 has brought into focus questions about whether vaccines have an impact on the management of migraine and other headache disorders. Currently, only messenger ribonucleic acid (mRNA), adenovirus-vectored, and purified protein COVID-19 vaccines to soon be available. In each of these vaccine platforms, the only severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virally derived immunologic target present is the SARS-CoV-2 full-length S (spike) protein encoded in mRNA (Pfizer and Moderna vaccines), DNA (adenovirus-vectored vaccines; AstraZeneca or Johnson & Johnson), or the purified S protein with a proprietary adjuvant (Novavax). Thus, vaccine-induced protective immune responses are confined to the S protein and its epitopes, and phase III clinical trials across a wide diversity of age, race, sex, and multiple comorbidities have demonstrated excellent efficacy. Notably, while many patients with migraine and other headache disorders likely entered the COVID-19 vaccine clinical trials, specific data on any association between vaccine immunogenicity, safety, or efficacy and migraine treatments have not been reported, and such analyses likely not performed.

The clinical questions fall into two broad categories: (1) Does migraine treatment impair the efficacy, or impact the safety, of the COVID-19 vaccine and (2) Does the COVID-19 vaccine adversely impact the efficacy of migraine treatments? These questions seem to have focused most on onabotulinumtoxinA and the calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs), perhaps because they are delivered by injection. In addition, as non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for the acute treatment of migraine, there is also the question of whether their use should be curtailed for a period of time following vaccine administration in order to avoid inhibiting the body's immune response. Below we comment on the common questions that arise in regard to these treatments and COVID-19 vaccine immune response in adults. As there are no published data on these topics, these comments are based on expert opinion.