Department of Neurology, Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey.
Department of Neurology, Ermenek State Hospital, Karaman, Turkey.
J Headache Pain. 2023 Sep 29;24(1):132. doi: 10.1186/s10194-023-01665-3.
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.
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, 3 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.
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).
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.
虽然人们广泛认识到 COVID-19 疫苗接种后会出现急性头痛，但这些头痛的长期进展仍知之甚少。我们的目的是确定与 COVID-19 疫苗接种相关的持续性或加重性头痛的各种表型，并记录这些表型在较长时间内的变化。此外，我们旨在记录患有原发性头痛患者的各种头痛表现。
进行了一项多中心、前瞻性观察研究，以调查与 COVID-19 疫苗接种相关的持续性或加重性头痛。该研究制定了评估 COVID-19 疫苗接种相关头痛的三个时间点（初始就诊、3 个月随访和 6 个月随访）的问卷。头痛专家/临床医生前瞻性地使用这些问卷评估患者。通过重复 K 均值聚类分析，确定与 COVID-19 疫苗接种相关的持续性或加重性头痛患者的特征。
在纳入研究的 174 名患者中，女性与男性的比例为 128（73.6%）比 46（26.4%）。患者组的平均年龄为 45.2±13.3 岁，107 名患者（61.5%）有原发性头痛的既往病史。通过分析，根据每次就诊时的头痛特征确定了两个主要聚类。在第一次就诊时（n=174），聚类 1 主要包括有原发性头痛史、疼痛位于额部、搏动性疼痛类型、头痛更严重并伴有恶心、恐声、恐光和恐嗅等症状、活动后加重的患者。相比之下，聚类 2 包括头痛持续时间较长（超过一个月）且疼痛呈刺痛/压迫感的患者。与聚类 2 相比，聚类 1 中以偏头痛为既往原发性头痛障碍的患者比例更高（分别为 90.48%比 68.18%；p=0.005）。
确定与 COVID-19 疫苗接种相关的持续性或加重性头痛的两种不同表型可以提供有价值的临床见解。了解 COVID-19 疫苗接种后头痛可能加重，特别是在偏头痛等原发性头痛障碍患者中，有助于临床医生和头痛专家相应地预测和调整治疗策略。这一知识可以帮助预先规划治疗调整并优化患者护理。
