COVID-19 vaccination-related headache showed two different clusters in the long-term course: a prospective multicenter follow-up study (COVA-Head Study)

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.

One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases

BACKGROUND

Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases.

METHODS

The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice.

RESULTS

Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances.

CONCLUSION

A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.

The effect of weather variables on the severity, duration, and frequency of headache attacks in the cases of episodic migraine and episodic tension-type headache

Background/aim

Although many headache patients report that the frequency and severity of attacks vary according to the season or weather in clinical practice, the relationship between the characteristics of the attacks and the weather is not very clear in episodic headaches. We aimed to compare the effects of weather variables (temperature, wind speed, wind direction, humidity, pressure, ultraviolet index, and sunshine duration) on episodic migraine (EM) and episodic tension-type headache (ETTH) attacks (incidence, duration, and severity).

Materials and methods

Fifty patients with EM and fifty patients with ETTH diagnosed according to International Classification of Headache Disorders-II are included in the study. Patients were given one diary for headache follow-up. The evaluation form on the relationship between the duration, frequency, and severity of the pain and the findings obtained from the headache diaries were compared with the daily weather data, and the two headache groups were compared with each other in terms of the effect of meteorological data on the pain characteristics.

Results

It is determined that mean wind velocity in EM attacks is significantly higher when compared to the tension-type headache (TTH) attacks and mean UV index is significantly higher in TTH attacks (p = 0.018 and 0.039). Mean UV index in TTH attack days was reported higher in women than men (p = 0.044). Mean sunshine duration in TTH attack days was reported longer in women than men (p = 0.050). When mean age gets higher in patients with migraine, mean temperature in the days of attack gets lower (r = –0.146 and p = 0.046).

Conclusion

During the treatment of migraine and TTH patients, recommendations and warnings about weather conditions can be made. This information can guide patients to regulate their daily living activities. The importance of considering the weather-headache relationship during the review of the current treatment in cases of unresponsiveness to treatment should be kept in mind.