Migraine Treatments Do Not Affect COVID-19 Vaccine Immunogenicity


Experts discussed clinical questions regarding migraine treatments and COVID-19 vaccines.


There is no evidence that over-the-counter and prescription migraine treatments affect the immunogenicity of COVID-19 vaccinations, according to headache experts.

Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, calcitonin-gene-related peptide (CGRP) monoclonal antibody (mAb) treatments, and onabotulinumtoxinA (Botox; Allergan) should not affect patients’ immune response when receiving COVID-19 vaccines, according to a guest editorial published in Headache: The Journal of Headache and Face Pain. The authors discussed clinical questions regarding migraine treatments and COVID-19 vaccine efficacy and safety in the editorial.

No specific studies of the use of acetaminophen and/or NSAIDs have been done to examine any effect on COVID‐19 vaccine immunogenicity in adults, wrote Amy A. Gelfand, MD, director of the Child & Adolescent Headache Program at the University of California, San Francisco, and Gregory Poland, MD, founder of the Mayo Vaccine Research Group at Mayo Clinic in Rochester, Minnesota.

Although the CDC does not recommend routine prophylactic use of NSAIDs or acetaminophen before a vaccine, the organization said they can be taken for treatment of post‐vaccination local or systemic reactions if needed.

Information on the impact of such use on mRNA COVID‐19 vaccine‐induced antibody responses is not available currently, according to the CDC.

However, in the AstraZeneca clinical trials of the adenovirus‐vectored vaccine, several sites utilized pre‐injection prophylactic paracetamol to reduce vaccine reactogenicity with no apparent detrimental effect on subsequent antibody response, the authors wrote.

“Furthermore, the mRNA and adenovirus‐vectored COVID‐19 vaccines appear to induce very high levels of protective antibody levels—higher than what many believe may be needed for protective efficacy….Given the high level of antibody response and extraordinary efficacy of the mRNA vaccines, and the need for readily available over‐the‐counter treatment of migraine and other headache disorders, our opinion would be to use either medication as needed for treatment,” they said.

Preventive CGRP mAb treatments will also not impair the body’s immunologic response to any COVID‐19 vaccine, according to the authors. “…Clinical trial evidence with these mAbs has not suggested that they are immunosuppressive or myelosuppressive—nor would they be expected to be given the molecular engineering they have undergone,” the authors wrote.

“At this point, there are no data to suggest that such treatments would in any way interfere with COVID‐19 vaccine immunogenicity, safety, or efficacy,” they added.

Some patients receiving onabotulinumtoxinA (Botox) for migraine treatment may wonder whether onabotulinumtoxinA is considered a dermal filler. The FDA reported that 2 participants in the Moderna COVID‐19 vaccine trial who had dermal fillers experienced facial swelling in those areas after receiving the Moderna mRNA vaccine.

However, Botox is not concerned a facial filler. “Facial fillers are substances injected to provide volume or fullness, and are unrelated to onabotulinumtoxinA. Therefore, this observation is not pertinent to patients receiving onabotulinumtoxinA injections for treatment of chronic migraine,” the authors wrote.

In addition, there is “no reason to think” that onabotulinumtoxinA impairs the immune response to any COVID‐19 vaccine, they wrote. As such, the authors concluded that there is no evidence to suggest that preventive migraine should be delayed with regard to timing of COVID-19 vaccine administration.


Gelfand A, Poland G. Migraine treatment and COVID-19 vaccines: no cause for concern. Headache: The Journal of Headache and Face Pain. February 5, 2021. https://doi.org/10.1111/head.14086

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