Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis.

García-Azorín, David; Do, Thien Phu; Gantenbein, Andreas R; Hansen, Jakob Møller; Souza, Marcio Nattan P; Obermann, Mark; Pohl, Heiko; Schankin, Christoph J.; Schytz, Henrik Winther; Sinclair, Alexandra; Schoonman, Guus G; Kristoffersen, Espen Saxhaug (2021). Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis. The journal of headache and pain, 22(1), p. 108. BioMed Central 10.1186/s10194-021-01324-5

Garcia-Azorin__2021__Delayed_headache_after_COVID-19_vaccination_a_red_flag_for_vaccine_induced_cerebral_venous_thrombosis.pdf - Published Version
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Headache is a frequent symptom following COVID-19 immunization with a typical onset within days post-vaccination. Cases of cerebral venous thrombosis (CVT) have been reported in adenovirus vector-based COVID-19 vaccine recipients.


We reviewed all vaccine related CVT published cases by April 30, 2021. We assessed demographic, clinical variables and the interval between the vaccination and onset of headache. We assessed whether the presence of headache was associated with higher probability of death or intracranial hemorrhage. We identified 77 cases of CVT after COVID-19 vaccination. Patients' age was below 60 years in 74/77 (95.8%) cases and 61/68 (89.7%) were women. Headache was described in 38/77 (49.4%) cases, and in 35/38 (92.1%) was associated with other symptoms. Multiple organ thrombosis was reported in 19/77 (24.7%) cases, intracranial hemorrhage in 33/77 (42.9%) cases and 19/77 (24.7%) patients died. The median time between vaccination and CVT-related headache onset was 8 (interquartile range 7.0-9.7) days. The presence of headache was associated with a higher odd of intracranial hemorrhage (OR 7.4; 95% CI: 2.7-20.8, p < 0.001), but not with death (OR: 0.51, 95% CI: 0.18-1.47, p = 0.213).


Delayed onset of headache following an adenovirus vector-based COVID-19 vaccine is associated with development of CVT. Patients with new-onset headache, 1 week after vaccination with an adenovirus vector-based vaccine, should receive a thorough clinical evaluation and CVT must be ruled out.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph Josef


600 Technology > 610 Medicine & health




BioMed Central




Chantal Kottler

Date Deposited:

24 Nov 2021 07:56

Last Modified:

28 Nov 2021 01:50

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Cerebrovascular disorders; Stroke Headache disorders Secondary; sinus thrombosis Vaccine-induced immune thrombotic thrombocytopenia




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