Evidence-based strategies to reduce intravenous immunoglobulin-induced headaches

Abstract

Objective: To review the literature evaluating pharmacotherapeutic and nonpharmacotherapeutic options available to reduce migraines or headaches associated with intravenous immunoglobulin (IVIG) treatment.

Data sources: A search of MEDLINE (1946 to February 2015) and other secondary resources was performed using the terms immunoglobulin, immune globulin, intravenous immunoglobulins, migraine, and headache. Other relevant articles referenced from the MEDLINE search were also utilized.

Study selection and data extraction: Data sources were limited to English language clinical trials and case studies. In all, 6 clinical studies and 2 case reports met the criteria.

Data synthesis: Headaches or migraines are common adverse effects associated with the administration of IVIG. We evaluated 6 clinical studies and 2 case reports discussing this adverse event in patients treated with IVIG. Strategies used were hydration, switching to an alternate IVIG product, decreased infusion rates, or treating with oral analgesics, opioids, propranolol, sumatriptan, or dihydroergotamines before, during, or after the IVIG infusion. Overall, the majority of patients experienced improvement in headache symptoms, suggesting benefit, after using the various strategies discussed. However, the evidence is limited to case reports and clinical studies with small sample sizes that do not directly measure cause and effect of headache resolution and therapy given in those treated with IVIG.

Conclusions: An individualized treatment plan consisting of a pharmacotherapy or nonpharmacotherapy strategy used in the literature should be recommended after careful consideration of the patient's condition, specific IVIG product used, history of migraine, and previously failed and successful therapies.

Keywords: headache; immune globulin; immunoglobulin; intravenous immunoglobulins; migraine.