Treatment of COVID-19 Vaccine-triggered Migraine

A 55-year-old woman with a long history of chronic migraines saw her symptoms worsen after getting a COVID-19 mRNA vaccine. Normally, her migraines were manageable with topiramate and sertraline. Despite medication adjustments, her pain escalated, scoring a 9 on the Visual Analogue Scale (VAS).

The underlying mechanisms of how SARS-CoV-2 impacts the nervous system remain unclear. Research suggests that the virus can invade the nervous system and trigger headaches by causing inflammation and vascular changes. Headache and loss of smell (anosmia) are thought to be linked to this direct neural invasion.

Calcitonin gene-related peptide (CGRP) is key in migraine pathophysiology, involved in pain transmission and inflammation. Elevated levels of interleukin (IL)-6 and tumor necrosis factor alpha (TNF-a), common in COVID-19, also increase CGRP, influencing symptoms like cough, fever, and pain.

Studies have found structural similarities between CGRP receptors and SARS-CoV-2 spike proteins, suggesting a potential link to persistent post-COVID headaches. Treatments with CGRP monoclonal antibodies (mAb) have shown promise in reducing such persistent headaches.

Preventive migraine medications like Aimovig (erenumab-aooe), Vyepti (eptinezumab-jjmr), Ajovy (fremanezumab-vfrm), and Emgality (galcanezumab-gnlm) work by either obstructing the CGRP receptor or neutralizing the CGRP protein itself. These medications belong to a category of biologic drugs known as monoclonal antibodies. While injections such as Aimovig, Ajovy, Vyepti, and Emgality are approved for both chronic and episodic migraines, Nurtec is an oral medication approved for both migraine prevention and acute treatment.

The new study from Istanbul demonstrated that CGRP mAb treatment could improve headaches induced by COVID-19 vaccination. Concurrent studies are investigating the use of CGRP antagonists for treating respiratory complications related to COVID-19, suggesting not just their safety but also their potential for clinical improvement.


REFERENCES

Duman SC, Özkan E, Özdemir YG. Treatment of COVID-19 Vaccine Resistant Migraine Attack with CGRP Monoclonal Antibody: A Case Report. Noro Psikiyatr Ars. 2023 Aug 12;60(3):292–4. doi: 10.29399/npa.28266. PMCID: PMC10461765. 

Yapici-Eser H, Koroglu YE, Oztop-Cakmak O, Keskin O, Gursoy A, Gursoy-Ozdemir Y. Neuropsychiatric symptoms of COVID-19 explained by SARS-CoV-2 proteins'mimicry of human protein ınteractions. Front Hum Neurosci. 2021;15:656313.

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