Status migrainosus: a potential adverse reaction to Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine—a case report

DOI: https://doi.org/10.1007/s10072- 021- 05741- x

Abstract-Summary During the last months, different types of vaccines have been designed to contain the ongoing SARS-CoV-2 pandemic, with successful results in many countries.

Comirnaty (Pfizer/BioNtech) COVID-19 vaccine is a lipid nanoparticle- formulated, nucleoside mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2.

In the present report, we describe a case of SMg that lasted 11 days, time corre- lated with the second dose of COVID-19 vaccine (Pfizer/Comirnaty) in a 37-year- old woman with a history of migraine without aura.

In patients with a history of migraine, COVID-19 vaccination could lead to a

worsening of headache and, in rare cases, to the development of a SMg.

Extended: In the present report, we describe a case of SMg following with the administration of the second dose of Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine in a patient with a history of migraine without aura.

In the present report, we described a patient with SMg triggered by the second

booster of Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine.

Introduction Headache is one of the most frequent side effects due to coronavirus disease-19 (COVID-19) vaccines [332].

In the population vaccinated with Comirnaty (Pfizer/BioNtech) vaccine, both

migraine and tension-type headaches have been described.

According to International Classification of Headache Disorders (ICHD-3), sta- tus migrainosus (SMg) is a severe condition characterized by migraine attacks, moderate-severe in intensity, lasting for more than 72 h [76].

In the present report, we describe a case of SMg following with the administra- tion of the second dose of Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine in a patient with a history of migraine without aura.

Case Presentation The patient reported poor responsiveness to analgesic treatment with non-steroidal anti-inflammatory drugs (NSAIDs).

According to the patient, symptoms started the day after taking the second

booster of Comirnaty (Pfizer/BioNtech) COVID-19 vaccine.

Patient past medical history revealed a diagnosis of migraine without aura with low-frequency attacks (3–4 attacks per month) usually responsive to orally admin- istered Ibuprofen 400 mg.

The patient neurological examination was normal. A steroid therapy with intravenous hydrocortisone 1 g for 3 days was suggested

but refused by the patients due to fear of steroid side effects.

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5 Future Directions

After 4 days, the patient referred a little improvement of her condition with ibu- profen 400  mg administration even though a moderate (VAS 4-5/10) migraine persisted.

Discussion About 30% of vaccinated people have experienced headache as a side effect, even without a previous history of chronic headache [342].

A recent study [343] shows that in the Italian population, the risk of developing (Pfizer/BioNtech) headache/migraine episodes after COVID-19 vaccine was 2.78-fold higher than the daily frequency of headache disorders.

receiving Comirnaty

The association between headache and COVID-19 vaccines could be explained

by the immune response which takes place after the vaccination.

In the present report, we described a patient with SMg triggered by the second

booster of Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine.

The diagnosis of post-Comirnaty (BNT162b2, BioNtech/Pfizer) vaccine SMg was made according to the close relationship between the onset of headache and the vaccination.

The present report shows that SMg can represent a rare side effect of Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine in people suffering from migraine.

Acknowledgement A machine generated summary based on the work of Consoli, Stefano; Dono, Fedele; Evangelista, Giacomo; D’Apolito, Maria; Travaglini, Daniela; Onofrj, Marco; Bonanni, Laura 2021 in Neurological Sciences.

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Tele-Medicine

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Towards eHealth to support the health journey of headache patients: a scoping review