Comparison of headaches after SARS-CoV-2 vaccination

Headaches after vaccination against the SARS-CoV-2 virus show a broad symptom complex, suggesting a specific phenotype. The BioNTech/Pfizer vaccine displayed the lowest headache intensity, the shortest headache duration, and the longest onset latency after vaccination [1]. The results regarding the BioNTech/Pfizer vaccine and the AstraZeneca vaccine have recently been published [2,3].  

Headaches are among the most frequent side effects after vaccination against SARS-CoV-2. “More than half of patients receiving vaccines report headaches,” said Dr Carl Göbel (Universitätsklinikum Schleswig-Holstein, Germany).

The incidence of headaches was 55.1% after the Pfizer/BioNTech vaccine (BNT162b2), 57.5% after the AstraZeneca vaccine (AZD1222), and 64.7% after the Moderna vaccine (mRNA-1273) [4–6]. “mRNA vaccines are used for the first time,” Dr Göbel added. “A new headache phenotype has appeared, but the precise phenotype has not yet been described.” The aim of the current study was to compare this phenotype with and differentiate it from other forms of primary and secondary headaches.

Dr Göbel and colleagues developed a survey that was available both offline and online in order to capture the clinical characteristics of headache after vaccination. They distributed the survey to 12,000 care homes for the elderly as well as university hospitals in Germany and the United Arab Emirates [1].

Across all vaccines, the mean latency was 31.9 hours after vaccination. The latency with BioNTech/Pfizer was 34.4 hours, which was significantly longer than the Moderna vaccine (30.5 hours; P=0.008) and the AstraZeneca vaccine (26.7 hours; P<0.001).

Headache intensities across all vaccines were most frequently described as moderate or severe, although a substantial proportion of patients reported very severe headaches (see Figure). Headache intensity was lowest after BioNTech/Pfizer vaccination (3.52 on a scale of 0–5), which was significantly less intense than after Moderna (3.66; P<0.001) or AstraZeneca (3.55; P=0.03).

The headaches lasted on average 18.4 hours. Duration was shortest after BioNTech/Pfizer (17.7 hours) compared with the AstraZeneca vaccine (19.2 hours; not significant) and the Moderna vaccine (20.8 hours; P=0.04).

Figure: Headache intensities of all vaccines, frequency distribution [1]



According to Dr Göbel, this data has an important clinical implication for differentiating between post-vaccine headaches and headaches due to a cerebral venous thrombosis as a complication of vaccination. “Headaches due to the latter usually did not start until 5 days after vaccination, while the post-vaccination headaches usually disappeared by day 5.”

1. Göbel C, et al. Comparison of quantitative headache parameters of headache after vaccination against COVID-19 (Coronavirus SARS-CoV-2) with AZD1222, BNT162b2, mRNA-1273 and BBIBP-CorV vaccines. AL012, IHC 2021, 8–12 September.
2. Göbel CH, et al. Brain Commun. 2021;3(3):fcab169.
3. Göbel CH, et al. Pain Ther. 2021:1–22.
4. European Medicines Agency (2021). COVID-19 vaccine AstraZeneca. Assessment report. Procedure No. EMEA/H/C/005675/0000, EMA/94907/2021:1-181.
5. FDA Briefing Document. Pfizer-BioNTech COVID-19 Vaccine. Vaccines and related biological products advisory committee meeting December 10, 2020.
6. European Medicines Agency (2021). COVID-19 vaccine Moderna. Assessment report. Procedure No. EMEA/H/C/005791/0000, EMA/15689/2021 Corr.1:1–169.

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Posted on 8 November, 2021