COVID vaccine for patients with migraine?

There is no evidence to suggest migraine prevention treatment, including monoclonal antibodies that target the gene-related calcitonin peptide (CGRP) or onabotulinumtoxinA (Botox) injection, should delay if patients with migraine plan to receive COVID-19 vaccine, experts said.

The risks based on COVID-19 infection and the effectiveness of migraine prevention treatments “reinforce the importance of not delaying any of these interventions,” wrote Amy Gelfand, MD, University of California San Francisco, and Gregory Poland, MD, director of the Mayo Clinic Vaccination Research Group in Rochester, Minnesota, in an editorial published in A sore head.

“We do not have any data suggesting that any of the drugs used in treatment for migraine and other headache disorders inhibit the COVID-19 response,” said Poland, a senior editorial Vaccination, in an interview with MedPage today.

“Your migraine headache treatments do not have to be repeated due to the timing of your COVID-19 vaccine doses,” said Gelfand, editor A sore head. “If you feel a headache or fever after the vaccination and want to take something to treat these symptoms, taking NSAIDs or acetaminophen will not harm your ability to have an immune response to the vaccine,” she said. MedPage today.

In January, Gelfand asked the Twitter headache community: “Headache providers: What questions are your patients asking you about the COVID vaccine? What information do you want you to need? advise them better? “

The A sore head editorial was in response to questions that came out of that tweet. There were clinical questions in two broad categories: whether migraine treatment affected the efficacy or safety of COVID-19 vaccines, and whether the vaccine hindered the efficacy of migraine treatment.

“These questions appear to have been largely focused on onabotulinumtoxinA and CGRP pathway monoclonal pathways, possibly because they are delivered by injection,” Gelfand and Poland noted. attention.

A frequent question was whether monoclonal antibody treatment should be delayed CGRP pathway monthly or quarterly before 2 weeks of vaccination. Monoclonal antibodies that target the CGRP pathway include erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti).

Currently, only mRNA vaccines, adenovirus-vectored, and COVID-19 purified proteins are soon available, Gelfand and Poland noted. “In each of these vaccine platforms, the only immunologic target derived from oral SARS-CoV-2 is the presence of the SARS-CoV-2 full-length S (spike) protein a it was encoded either in mRNA (Pfizer and Moderna vaccines), DNA (adenovirus -vectored vaccines; AstraZeneca or Johnson & Johnson), or the property-purified S protein (Novavax), “they wrote.

Vaccine-induced immune responses are limited to the spike protein and its epitopes, and there is no reason to think that antibodies to SARS-CoV-2 spike proteins would induce onabotulinumtoxinA or antibodies to CGRP or its receptor, Poland said.

“Remember, with monoclonal antibodies, you are giving a precise treatment. You are inserting a matching key into a lock and other keys are not responding to that lock,” he said. . “As far as I can imagine, none of the monoclonal CGRP antibodies are going to affect the immune response of the COVID vaccine because they are different biologics and different modes of action and do not intercompany. Same as onabotulinumtoxinA. “

Headache patients who use NSAIDs or acetaminophen should continue if needed, Poland added. “There has been concern about a small reduction in antibody levels, seen primarily with first doses of routine infant vaccines and not as large as adult vaccines in general,” he said. on this with COVID vaccines. However, in the AstraZeneca trial, several of the clinical trial sites were pre-dosed with acetaminophen. “

“Like everything in my life, you balance risk and gain,” Poland continued. “If the use of acetaminophen or a non – steroidal drug is an important part of your headache treatment on a headache regimen, I would not stop that against the COVID vaccine.”

Although many patients with migraine and other headache disorders appear to have undergone COVID-19 vaccine clinical trials, no specific data on them have been reported. In the absence of published data on headache patients and the vaccine, the A sore head editorial is based on the opinion of experts, noted Gelfand and Poland.

“As always, individual patients should make treatment decisions with their healthcare professionals, taking into account their individual situation,” they wrote.