Are muscle twitches related to the COVID vaccines?

Q. Muscle twitches started shortly after receiving the Covavax vaccine. Why?

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Chithranjali Ravichandran
This is a premium question & answer published on Apr 16, 2021 and last reviewed on: May 05, 2021

Hello doctor,

I received the Novavax clinical trial COVID vaccine two months back. A few days later, I woke up, and my arms fell asleep. Well, shortly after that, muscle twitches started in my arm, then lower arm, hands, calves, thighs, lower back, and cheeks below my ear. They happen sporadically throughout the day. Some days are better than others. I did see a neurologist, and he did an EMG. I have attached a copy but did not really go in-depth about the results. Can you please look at these and tell me what you think? Of course, the first things I worry about are MS and ALS. He said these results show, but I do not have ALS. As you can guess, I have a lot of anxiety about this. Especially since the twitching has not stopped, can you please tell me if this EMG rules out ALS or not and if it was too soon to do the test?

Thank you very much.



Welcome to

I would like to know some further detail about your symptoms:

1. The muscle twitches at mentioned body parts happen simultaneously or occur at a different location at different timings?

2. Are these twitching increasing with time, or is it the same or decreasing with time?

3. Are these twitches visible by eyes or only felt inside by you?

4. Have you noticed any factor or situation aggravating it?

5. Do you have any limb weakness (decrease in the power of some action) or thinning limb?

6. Have you undergone any MRI scans of the brain or spine? If yes, please send it here as an attachment.

7. Do you have heart palpitation along with twitchings?

8. How is your sleep commonly?

- How long time it takes to get sleepy after lying in bed?

- Once sleepy, do you have a sound sleep? Or have frequent awakenings?

9. How is your mood commonly? Happy or sad or worried?

10. Are you already on any medicines? If yes, please tell their names, doses, and timings.

Investigations to be done:

MRI cervical spine with screening whole spine.
T3 (triiodothyronine), T4 (thyroxine), TSH (thyroid-stimulating hormone).
Serum Vitamin B12.
Serum Vitamin D3.
NCV (nerve conduction velocity) and EMG lower limbs + tongue + dorsal paravertebral muscles - your current NCV and EMG been performed only from upper limbs.

Differential diagnosis:

Similar electrophysiological findings may also be present in cervical myelopathy.

Treatment plan:

Your EMG was performed from upper limbs only, which showing slight abnormalities on NCV, not gross and few muscles of one segment showing abnormalities of only one segment (which also need to be clinically correlated).
ALS is a diagnosed, if it fulfills the criteria (clinical + electrophysiological) along with after ruling out other possible etiologies.
Many a time, diagnosis is possible only after time if symptoms or signs (clinical electrophysiological) progress and fulfill the diagnostic criteria.

Regarding follow up:

Please revert with above mentioned information and send your clinical neurological assessment and MRI scan (if performed) for better understanding and further decision making.

Hello doctor,

The twitching occurs at different times and at different locations and almost always at rest. The twitching has stayed about the same and has not increased or decreased. My fingers have been twitching, and for some reason, it seems that the twitching gets worst further into the week. I do work put every day and have not lost any power and can lift the same amount of weight. My pinky and ring finger do get numb rather often, especially when using my phone or have arms bent. The twitching is visible to the eye and on both sides of the body, mostly in my left calf. I have not noticed weakness in any muscles except my fingers occasionally. I did not have an MRI of the spine as my insurance did not cover it. Still, I did have a CT scan of the brain and upper spine that was normal. I do not have any heart palpitations. I have been sleeping terribly since this happened after the vaccine, wake up numerous times throughout the night. Also have had some night sweats. I do take testosterone every Tuesday as far as my mood seems that I am worried and angrier lately. I am on medicine, and I am on Xanax 1 mg twice a day and Testosterone 180 mg per week. I read your findings. As far as the Emg would you agree with my neurologist that this is not ALS? That is my biggest concern. This all happened after getting the first shot of the Novavax vaccine. I did not have a second done as advised by the doctor not to. I did have a blood test, and thyroid and vitamins were normal along with as well ANA cascading reflex blood test. Everything was normal. Slightly elevated CK levels, but I do work out everyday and normal Aldolase. Please advise if ALS is something to worry about.



Welcome back to

As per your description, it is difficult to straightway rule out ALS.

Xanax 1 mg is an anxiolytic medication.

As you do not have any clinical weakness or atrophy of any body part (as per your description), at this moment, you might not be fulfilling the criteria of ALS. Such twitchings called fasciculations can happen in many medical conditions. Also, it is difficult to say that it is related or unrelated to the vaccine, which seems unlikely.

Investigations to be done:

MRI cervical spine with screening whole spine.
Serum Vitamin B12.
Serum Vitamin D3.
NCV and EMG lower limbs + tongue + dorsal paravertebral muscles.

Differential diagnosis:

Anxiety Disorder.
Benign fasciculation syndrome.
Cramp Fasciculation Syndrome.
Motor Neuron disease.

Treatment plan:

You should undergone some further evaluation to rule out some other things. Along with can try antianxiety medications as your neurologist or psychiatrist suggest.
Also you should try daily jogging 30 minutes in morning with some meditation and yoga (very much helpful in anxiety).
If no other significant diagnosis is detected on further investigations, approach will be wait and watch to observe if any new symptoms or sign (on clinical examination) for ALS or other thing appear or not.
Mostly such twitchings are of benign nature.
You can discuss about other differential diagnosis (as mentioned) with your neurologist.

Regarding follow up:

Review SOS with mentioned reports.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
I have muscle twitching with tingling and balance problem. Is this ALS?

.. gone through the attached photo (attachment removed to protect patient identity). Your EMG (electromyography) is normal. We can exclude ALS (amyotrophic lateral sclerosis) in your case. It is necessary to do some investigations to rule out the possible   Read full

I have multiple sclerosis with shortness of breathe. Could paint spray fumes be the cause?

Hello doctor, I had unprotected anal sex with the neighbor lady before three years, and after a week I got jaundice, and it suffered around one month, and I got treatment with some ayurvedic medicines and got relief.   Read full

Can copper deficiency cause short-term memory loss and paresthesia of the face?

Hello doctor, I had unprotected anal sex with the neighbor lady before three years, and after a week I got jaundice, and it suffered around one month, and I got treatment with some ayurvedic medicines and got relief.   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions.  Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this.  Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades.  Read more»

Ask your health query to a doctor online?

Ask a Neurologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.