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Occipital neuralgia after COVID-19 vaccination: a report of two cases.

Sofia Malheiro

Background: A wide range of neurological complications has been described following the administration of COVID-19 vaccinations, with headache being the most commonly reported neurological adverse effect, with higher incidence after the second dose. The most common headache is a dull pain or migraine like. Still, two cases of trigeminal neuralgia and a case series of 7 patients with cluster headache who were clinically stable and had a new episode a few days after COVID-19 vaccination have also been reported. Herein, we describe the first two cases of occipital neuralgia developing after COVID-19 vaccination.

Cases Presentation: Two cases were observed in the neurology outpatient clinic of a tertiary university referral center in Portugal between October 2021 and June 2022.  Both patients developed the headache within 1 to 6 days after the second dose of BNT162b2 (Pfizer). One had no previous history of headaches, and the other had a migraine that was clearly different from the present headache. Each case is described, checked for ICHD criteria for occipital neuralgia, and its temporal relation with COVID-19 Vaccination is reported.

Conclusions: COVID-19 vaccination can trigger various types of headaches, far beyond the most commonly described feature of dull pain, possibly by activating an immune-inflammatory response.