Abstract text (incl. figure legends and references)

INTRODUCTION

Headache is the most commonly reported neurological adverse effect after COVID-19 vaccination, with mild to moderate headaches being reported in 25-52% of patients after BNT162b2. Herein, we describe the first case reported of an occipital neuralgia after BNT162b2.

CLINICAL CASE

A 39-year-old caucasian woman with no previous story of headache, was admitted to our hospital with two weeks of a bilateral paroxysmal stabbing shock-like pain beginning in the occipital zone. Six days before, she received the first dose of Pfizer-BioNtech vaccine against SARS-CoV-2, with fever reported in the first day after the administration of this vaccine. She had never experienced any kind of headaches after other vaccinations. The pain was a bilateral stabling shock-like pain, severe (intensity of 8/10), with a short duration (few seconds) and spontaneously initiated or triggered by touching or brushing the hair, appearing many times per day and, over the time, in the period between the shocks, she starts to feel a dull pain in the vertex and nuchal region, with concomitant dysesthesia in these zones. On examination, pressure over the occipital nerves revealed local tenderness and elicited a paroxysm of pain. A probable occipital neuralgia was considered, and bilateral occipital blockage had been performed in the emergency department, with significant relief of the pain. It was started gabapentin (up to 300 mg) and amitriptyline (up to 25 mg). Neuroimagiology (brain CT, brain and cervical MRI) was unremarkable. Since then, the patient has been re-evaluated in consultation, with 3-month intervals, with administration of large occipital nerve blockages, with significant improvement in shocking pain, and with progressive improvement in constant dull pain over the months.

CONCLUSION

Two cases of trigeminal neuralgia after COVID-19 vaccination had already been reported, however this is the first time that a case of occipital neuralgia after this vaccine is described.