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Takizawa T, Ihara K, Uno S, Ohtani S, Watanabe N, Imai N, Nakahara J, Hori S, Garcia-Azorin D, Martelletti P. Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in COVID-19 patients: a narrative review. Expert Opin Drug Metab Toxicol 2023; 19:951-967. [PMID: 37925645 DOI: 10.1080/17425255.2023.2280221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Migraine pharmacological therapies targeting calcitonin gene-related peptide (CGRP), including monoclonal antibodies and gepants, have shown clinical effect and optimal tolerability. Interactions between treatments of COVID-19 and CGRP-related drugs have not been reviewed. AREAS COVERED An overview of CGRP, a description of the characteristics of each CGRP-related drug and its response predictors, COVID-19 and its treatment, the interactions between CGRP-related drugs and COVID-19 treatment, COVID-19 and vaccination-induced headache, and the neurological consequences of Covid-19. EXPERT OPINION Clinicians should be careful about using gepants for COVID-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, COVID-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a COVID-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.
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Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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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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Mohebbi A, Eterafi M, Fouladi N, Golizadeh M, Panahizadeh R, Habibzadeh S, Karimi K, Safarzadeh E. Adverse Effects Reported and Insights Following Sinopharm COVID-19 Vaccination. Curr Microbiol 2023; 80:377. [PMID: 37861721 DOI: 10.1007/s00284-023-03432-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/28/2023] [Indexed: 10/21/2023]
Abstract
Vaccines are promising strategies for controlling COVID-19; however, COVID-19 vaccine side effects play a central role in public confidence in the vaccine and its uptake process. This study aimed to provide evidence on the post-vaccination early side effects of the BBIBP-CorV (Sinopharm) vaccine. This cross-sectional survey-based study was conducted between November 2021 and January 2022 among recipients of the BBIBP-CorV vaccine, using a questionnaire-based survey. Our final sample consisted of 657 participants, including 392 women. Among the study cases, only 103 (15.7%) participants received one dose of vaccine, and the rest received both doses (N = 554, 84.3%). Systemic symptoms (first dose: N = 187, both doses: N = 128) were the most commonly reported events after vaccination, and among them, injection site pain (first dose: 19.3%, both doses: 12.9%) was the most prevalent adverse effect. All reporting events were mild and resolved in less than 3 days without hospitalization. Among the participants, females and young people aged 35-65 were more prone to manifest side effects (N = 169, 53.3%) after the vaccine injection. Furthermore, our results revealed that the recipients who were suffering from underlying diseases, including diabetes, renal disorder, and respiratory illness, reported fewer adverse responses after vaccination in comparison with healthy individuals. Vaccination against SARS-CoV-2 may lead to some adverse reactions in recipients. However, the frequency of post-vaccination early side effects differed in people, but all responses were slight and temporary.
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Affiliation(s)
- Alireza Mohebbi
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Majid Eterafi
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Fouladi
- School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Majid Golizadeh
- Cancer Immunology and Immunotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Reza Panahizadeh
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shahram Habibzadeh
- Department of Internal Medicine, Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Kimia Karimi
- Students Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Safarzadeh
- Cancer Immunology and Immunotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
- Department of Microbiology, Parasitology, and Immunology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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Atalar AÇ, Acarlı ANÖ, Baykan B, Martelletti P, Bolay H, Ertaş M, Ekizoğlu E, Karadaş Ö, Polat B, Gençdal IY, Azorin DG, Mitsikostas D, Apostolakopoulou L, Genç H, Dikmen PY, Demirel EA, Aydınlar EI, Gözübatık-Celik RG, Shafiyev J, Taşdelen B, Özge A. COVID-19 vaccination-related headache showed two different clusters in the long-term course: a prospective multicenter follow-up study (COVA-Head Study). J Headache Pain 2023; 24:132. [PMID: 37773092 PMCID: PMC10541695 DOI: 10.1186/s10194-023-01665-3] [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: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Although acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches. METHODS A multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination. RESULTS Among the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 ± 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005). CONCLUSION The identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care.
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Affiliation(s)
- Arife Çimen Atalar
- Department of Neurology, Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey.
| | | | - Betül Baykan
- Department of Neurology, Headache Center, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
- Department of Neurology, EMAR Medical Center, Istanbul, Turkey
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Hayrunnisa Bolay
- Medical Faculty, Department of Neurology and Algology, Gazi University, Ankara, Turkey
| | - Mustafa Ertaş
- Department of Neurology, Headache Center, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, Headache Center, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ömer Karadaş
- Department of Neurology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Burcu Polat
- School of Medicine, Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Işıl Yazıcı Gençdal
- Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - David Garcia Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Headache Unit, Valladolid, Spain
| | - Dimos Mitsikostas
- First Neurology Department, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Loukia Apostolakopoulou
- First Neurology Department, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hamit Genç
- University of Health Sciences, Van Training and Research Hospital, Van, Türkiye
| | - Pınar Yalınay Dikmen
- School of Medicine, Department of Neurology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Elif Ilgaz Aydınlar
- School of Medicine, Department of Neurology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Rabia Gökçen Gözübatık-Celik
- Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Javid Shafiyev
- Department of Neurology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatic, Mersin University School of Medicine, Mersin, Turkey
| | - Aynur Özge
- Medical Faculty, Department of Neurology, Mersin University, Mersin, Türkiye
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Caronna E, Pozo-Rosich P. Virtual issue: COVID-19 and headache. Headache 2023; 63:183-184. [PMID: 36633206 DOI: 10.1111/head.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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