91 Effect of COVID vaccination on monthly migraine days 4 As far as we are aware, there is currently no published research that has investigated the potential impact of COVID-19 infection or vaccination on the severity of pre-existing migraine in a longitudinal cohort study. Importantly, our vaccination analyses results are consistent with a retrospective questionnaire study that showed an increase in length and severity of headache attacks in patients with migraine in the first week after COVID-19 vaccination.21 This study also reported that headaches were less responsive to usually effective pain medication, which is consistent with the increase in MAMD found in our study.21 While the general population may experience mild and temporary headaches after vaccination, individuals prone to migraine, who are already more susceptible to headache attacks, might encounter a more pronounced impact. Our study offers valuable insights into how patients with migraine specifically respond to COVID-19 vaccination. This follow up study shows that vaccination against COVID-19 is associated with an increase in migraine in the first month. COVID-19 infection solely increases the number of acute medication intake days. Our findings suggest that vaccination against COVID-19 is associated with an increase in migraine, which could indicate the involvement of inflammatory mediators in the pathophysiology of migraine and can impact the intrinsic threshold for upcoming attacks. Clinical implications • This follow-up study suggest that vaccination against COVID-19 is associated with an increase in migraine. • Our findings could indicate that the involvement of inflammatory mediators in the pathophysiology of migraine can impact the intrinsic threshold for upcoming attacks. • COVID-19 infection solely increases the number of acute medication intake days. Conflicts of Interest B.W.H. van der Arend and G.M. Terwindt report independent support from the Dutch Research Council (849200007) and the Dutch Brain Foundation (HA2017.01.05). G.M. Terwindt reports consultancy or industry support from Abbvie/Allergan, Lilly, Lundbeck, Novartis, and Teva, and independent support from the European Community, Dutch Heart and Brain Foundations, Dutch Research Council, and Dioraphte. E.W. van Zwet, M.M. Bloemhof and A.G. van der Schoor report no disclosures. Funding This project was not funded by any of the grants indicated in the COI section.
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