Headache intravenous immunoglobulin

The rate of adverse effects associated with intravenous immunoglobulin varies among different studies, which has been attributed to factors such as the indication, the dosage, the infusion rate, and the patient s age (12). In one study, headache and chills were related to a higher dosage. 

Of 56 patients with autoimmune diseases who received high dosages of intravenous immunoglobulin, 20 had at least one adverse effect after one or more courses of treatment (12). The most frequently reported adverse effects were low-grade fever, headache, and chills. The authors concluded that the occurrence of adverse effects with intravenous immunoglobulin was not related to the clinical response to treatment. However, patients who developed adverse effects during the first course of treatment were more at risk of adverse effects during subsequent courses. 

Patients with thrombocytopenia generally tolerate intravenous immunoglobulin well (35). In 16 young patients aged 9 months to 22 years with immune-mediated hemocytopenias (13 with childhood immune thrombocytopenic purpura), who received a total of 210 infusions, minimal adverse effects (transient headaches) were experienced during only four infusions, and later infusions were problem-free in three of the four patients (36). 

The most frequent adverse effects of intravenous immunoglobulin (Sandoz) for the treatment of various disorders (affecting 1-3% of patients in aU) were headache, nausea, vomiting, and fever. Some other mild sjmp-toms have an incidence below 1%, including abdominal pain, diarrhea, fatigue, malaise, dizziness, myalgia, and chest tightness. 

Headache occurred in 25% of all patients who received an infusion of intravenous immunoglobulin, probably related to larger volumes and fluid shifts, protein loads, and infusion rates (54). Intravenous immunoglobulin caused severe headache in 56% of patients without a history of migraine (55). The pathogenesis of this headache is unknown. 

Severe headache has also been reported in children with idiopathic thrombocytopenic purpura using intravenous immunoglobulins (33). In a randomized, controlled study of patients with myasthenia gravis, two of six patients who received intravenous immunoglobulin developed severe headache after the initial dose of 2 g/kg (56). 

Mild adverse effects of intravenous immunoglobulin, such as headache, chills, nausea, backache, and flushing, occur at a rate of 5-10% (101,135). Most of these... 

Finkel AG, Howard JF Jr, Mann JD. Successful treatment of headache related to intravenous immunoglobulin with antimigraine medications. Headache 1998 38(4) 317-21. 

Susceptibility factors Patients with a history of migraine may have more severe and persistent headache after intravenous immunoglobulin [39",4r]. 

The most commonly reported adverse events are mild local injection reactions, such as erythema, edema, swelling, pruritus, and local heat [48 , 60, 63 ], whose incidence decreases over time [48 ]. The incidence of non-infusion-site reactions after subcutaneous administration (0.24 events per infusion) is similar to the total incidence of 0.25 events per infusion during treatment with intravenous immunoglobulin [48 ]. Non-infusion-site adverse events after subcutaneous administration include headache, diarrhea, fatigue, and nausea [48 "]. 

A 14-year-old Japanese girl with Guillain— Barre syndrome was given intravenous immunoglobulin 0.4 g/kg/day and after 3 days developed severe headaches without disturbed consciousness [62 ]. An MRI scan of the brain showed characteristics consistent with posterior reversible encephalopathy syndrome. After the end of the course of intravenous immunoglobulin she recovered. 

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