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Mitsikostas DD, Caronna E, De Tommaso M, Deligianni CI, Ekizoglu E, Bolay H, Göbel CH, Kristoffersen ES, Lampl C, Moro E, Pozo‐Rosich P, Sellner J, Terwindt G, Irimia‐Sieira P. Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review. Eur J Neurol 2024; 31:e16251. [PMID: 38415282 PMCID: PMC11235838 DOI: 10.1111/ene.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND PURPOSE The aim was to provide insights to the characteristics of headache in the context of COVID-19 on behalf of the Headache Scientific Panel and the Neuro-COVID-19 Task Force of the European Academy of Neurology (EAN) and the European Headache Federation (EHF). METHODS Following the Delphi method the Task Force identified six relevant questions and then conducted a systematic literature review to provide evidence-based answers and suggest specific diagnostic criteria. RESULTS No data for facial pain were identified in the literature search. (1) Headache incidence during acute COVID-19 varies considerably, with higher prevalence rates in prospective compared to retrospective studies (28.9%-74.6% vs. 6.5%-34.0%). (2) Acute COVID-19 headache is usually bilateral or holocranial and often moderate to severe with throbbing pain quality lasting 2-14 days after first signs of COVID-19; photo-phonophobia, nausea, anosmia and ageusia are common associated features; persistent headache shares similar clinical characteristics. (3) Acute COVID-19 headache is presumably caused by immune-mediated mechanisms that activate the trigeminovascular system. (4) Headache occurs in 13.3%-76.9% following SARS-CoV-2 vaccination and occurs more often amongst women with a pre-existing primary headache; the risk of developing headache is higher with the adenoviral-vector-type vaccines than with other preparations. (5) Headache related to SARS-CoV-2 vaccination is mostly bilateral, and throbbing, pressing, jolting or stabbing. (6) No studies have been conducted investigating the underlying mechanism of headache attributed to SARS-CoV-2 vaccines. CONCLUSION The results of this joint EAN/EHF initiative provide a framework for a better understanding of headache in the context of SARS-CoV-2 infection and vaccination.
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Affiliation(s)
| | - Edoardo Caronna
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina De Tommaso
- Neurophysiopathology Unit, DiBrain DepartmentAldo Moro UniversityBariItaly
| | | | - Esme Ekizoglu
- Department of Neurology, Faculty of MedicineIstanbul University, IstanbulIstanbulTurkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROMGazi University AnkaraAnkaraTurkey
| | - Carl H. Göbel
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Espen Saxhaug Kristoffersen
- Department of NeurologyAkershus University HospitalLørenskogNorway
- NorHEAD, Norwegian Centre for Headache ResearchAkershus University HospitalLørenskogNorway
- Department of General Practice, HELSAMUniversity of OsloOsloNorway
| | - Christian Lampl
- Department of Neurology and Stroke UnitKonventhospital Barmherzige Brüder LinzLinzAustria
- Headache Medical Center LinzLinzAustria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes UniversityGrenobleFrance
| | - Patricia Pozo‐Rosich
- Headache Unit, Neurology DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Headache and Neurological Pain Research Group, Department of MedicineVall d'Hebron Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Johann Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
| | - Gisela Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
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Alzahrani MS. Implementing a School-Entry Mandate for the Human Papillomavirus Vaccine: Benefits and Challenges. Cureus 2024; 16:e62519. [PMID: 39022520 PMCID: PMC11253561 DOI: 10.7759/cureus.62519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Human papillomavirus (HPV), a common sexually transmitted infection, has prompted the development of vaccines to mitigate associated cancer risks, particularly cervical cancer. Regions that have achieved a high rate of vaccination coverage are witnessing a transformative impact on public health, with a notable reduction of up to 30% in the incidence of cervical cancer cases. Emphasizing the broader impact of vaccination on public health, this review investigates the role of a school-entry mandate for the HPV vaccine, aiming to inform decisions about its potential benefits and challenges. With a focus on understanding the significance of vaccination, the review delves into its potential to reduce the physical, emotional, and financial burdens associated with HPV-associated cancers. Implementing school-entry mandates for the HPV vaccine offers benefits such as increased vaccination rates, protection against HPV-related diseases, and long-term health advantages. However, challenges include ethical concerns, parental opposition, and logistical issues. Successful implementation requires clear communication, collaboration, and education, with legal and ethical considerations addressing constitutional rights, liability concerns, autonomy, and equitable access. In summary, the implementation of school-entry mandates for the HPV vaccine offers the potential for increased vaccination rates and the reduction of health disparities. However, this approach is challenged by factors such as opposition, associated costs, and legal and ethical considerations. The decision to mandate the HPV vaccine requires a delicate balance between public health priorities and individual rights, necessitating clear communication, education, and collaborative efforts to address the complexities involved.
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Affiliation(s)
- Mohammad S Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, SAU
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Aşkın Turan S, Aydın Ş. A retrospective cohort study: is COVID-19 BNT162b2 mRNA vaccination a trigger factor for cluster headache? Acta Neurol Belg 2024:10.1007/s13760-024-02536-7. [PMID: 38619748 DOI: 10.1007/s13760-024-02536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTıVE: Cluster headache (CH) is a coronavirus 2019 (COVID-19) vaccination-related adverse event. There are a few case reports of relapses or de novo cluster episodes following the vaccine. The disease's pathophysiology is still not clear. The most widely accepted mechanism is activation of the trigeminocervical complex (TCC). However, the correlation between vaccination and CH is unexplainable. Its goal is to compare the CH bouts of patients before and after the vaccine. METHODS Patients with a history of CH and who had never experienced COVID-19 illness during the pandemic were included in this retrospective cohort analysis. The semi-structured survey was administered face to face to 24 CH patients (16 male). The headache features before and after vaccination were detailed in this survey. RESULTS 18 patients got vaccinated twice, and 6 of them had no vaccination. After the first vaccination, 83.3% of them had CH bout; after the second vaccination, 72.2% of them had CH bout. We divided headache episodes into three groups: (1) before vaccination, (2) after the first vaccination, and (3) after the second vaccination. The third group had a higher pain intensity (9.30 ± 0.630, p = 0.047) and remitting longer (20.00 ± 5.40 days, p = 0.019) than the other groups. The management of the 53.3% bouts after vaccinations was less effective than the usual episodes. CONCLUSION Most ECH patients experienced new bouts more intense and longer duration after vaccinations than their previous bouts, the mechanism, and pathogenesis of the bouts are the subject of future research. The new studies can be a light for understanding the CH pathophysiology more deeply.
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Affiliation(s)
- Suna Aşkın Turan
- Pain Department, Mersin City Training and Research Hospital, University of Health Sciences, 33240, Korukent Mah. 96015 Sok. Mersin Entegre Sağlık Kampüsü, Toroslar/Mersin, Türkiye.
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
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Robbins M. New Daily Persistent Headache. Continuum (Minneap Minn) 2024; 30:425-437. [PMID: 38568492 DOI: 10.1212/con.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article describes the clinical features, etiology, differential diagnosis, management, and prognosis of new daily persistent headache. LATEST DEVELOPMENTS New daily persistent headache has attracted renewed attention as it may arise in the setting of a COVID-19 infection. Spontaneous intracranial hypotension, particularly from CSF-venous fistulas, remains an important secondary headache disorder to consider before diagnosing new daily persistent headache. Symptomatic treatment for new daily persistent headache may include acute and preventive therapies used for migraine and tension-type headache, such as triptans, oral preventive agents, onabotulinumtoxinA, and agents that target calcitonin gene-related peptide. ESSENTIAL POINTS New daily persistent headache is a daily headache syndrome that starts acutely and can only be diagnosed after 3 months have elapsed and other secondary and primary headache diagnoses have been excluded. The clinical manifestations largely resemble either chronic migraine or chronic tension-type headache. The underlying cause is unknown, but it is plausible that multiple etiologies exist and that it is not a single disease entity. The prognosis is variable but often poor, and the treatment approach is largely extrapolated from the management of chronic migraine and chronic tension-type headache.
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Zhou Q, Eggert T, Zhelyazkova A, Choukér A, Adorjan K, Straube A. Questionnaire-based study of COVID-19 vaccination induced headache: evidence of clusters of adverse events. BMC Neurol 2024; 24:84. [PMID: 38431578 PMCID: PMC10908065 DOI: 10.1186/s12883-024-03583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The adverse events (AEs) after a Coronavirus disease 2019 (Covid-19) Pfizer-Biotech mRNA vaccination present a medical and epidemiological issue of increasing interest. Headache is the most frequent neurological adverse effect and generally the third most common adverse event after a Covid-19 vaccination, but only a few studies focus on the link between headache and other AEs after vaccination. This study aims to investigate the correlation between headaches and Covid-19 vaccination, as well as the possible links between headaches and other AEs after Covid-19 vaccination, thereby helping the management of AEs and avoiding further occurrences. METHODS This study is based on a published questionnaire survey of 1,402 healthcare workers. Our study focused on the 5 questions including 12 AEs and headaches extracted from the questionnaire post the first and second Covid-19 vaccination. The severity of the 12 AEs and headaches could be classified by the participants on a five-step scale: "Not at all", "Little", "Average", "Quite", and "Very" (abbreviated as "N", "L", "A", "Q", "V"). We used the Bowker test to study the comparison of headache severity, indicated on a 5-point Likert scale between the first and second vaccinations. We applied an ordinal logistic regression to the 5 categories with headache severity serving as the dependent variable and the ratings of the other 12 AEs serving as the independent variable to further explore to what extent the severity of the 12 AEs is associated with the severity of headaches. Receiver Operating Characteristic (ROC) analysis was conducted to evaluate the predictive value of the ratings of the 12 AEs to headache severity. RESULTS We found that participants rated their headaches as more severe after the second vaccination, and participants who reported experiencing fatigue, flu-like symptoms, pain at the injection site, known tension-type headache, fever, dizziness/balance problems and known migraine are associated with headache symptoms. CONCLUSIONS There are clusters of headache-associated AEs post Covid-19 vaccination. The association of various AEs with headaches may be due to similar causative mechanisms.
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Affiliation(s)
- Qiao Zhou
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr.15, 81377, Munich, Germany
| | - Thomas Eggert
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr.15, 81377, Munich, Germany
| | - Ana Zhelyazkova
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, 80336, Munich, Germany
| | - Alexander Choukér
- Laboratory of Translational Research Stress and Immunity, Department of Anaesthesiology, University Hospital Munich, Ludwig Maximilian University of Munich, 81377, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr.15, 81377, Munich, Germany.
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González-Celestino A, González-Osorio Y, García-Iglesias C, Echavarría-Iñiguez A, Sierra-Mencía A, Recio-García A, Trigo-López J, Planchuelo-Gómez A, Hurtado ML, Sierra-Martínez L, Ruiz M, Rojas-Hernández M, Pérez-Almendro C, Paniagua M, Núñez G, Mora M, Montilla C, Martínez-Badillo C, Lozano AG, Gil A, Cubero M, Cornejo A, Calcerrada I, Blanco M, Alberdí-Iglesias A, Fernández-de-Las-Peñas C, Guerrero-Peral AL, García-Azorín D. Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study. Rev Neurol 2023; 77:229-239. [PMID: 37962534 PMCID: PMC10831767 DOI: 10.33588/rn.7710.2023063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache. SUBJECTS AND METHODS A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed. RESULTS A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements. CONCLUSION Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.
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Affiliation(s)
| | | | - C García-Iglesias
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | | | - A Sierra-Mencía
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Recio-García
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Trigo-López
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - M L Hurtado
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - L Sierra-Martínez
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Ruiz
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Rojas-Hernández
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - C Pérez-Almendro
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Paniagua
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - G Núñez
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Mora
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - C Montilla
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - C Martínez-Badillo
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - A G Lozano
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - A Gil
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Cubero
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - A Cornejo
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - I Calcerrada
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - M Blanco
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | - A Alberdí-Iglesias
- Área Básica de Salud de Atención Primaria Valladolid Este, Valladolid, España
| | | | | | - D García-Azorín
- Universidad de Valladolid, Valladolid, España
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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