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Topics:
Internal Medicine • Rheumatology • Myositis • IVIG • General Rheumatology • Neurology • Allergy & Immunology • Headache • Primary Immunodeficiency • Neurohospitalist
How do you treat post-IVIG headache that is not responsive to Tylenol or NSAIDs?
Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate can be helpful.
Answer from: at Community Practice
In my opinion, there is no one simple treatment for such headaches.
We try slowing the infusion rate, premedicate with steroids, low dose Lasix, or premedicate with Nurtec.
Usually, one of these methods helps minimize or eliminate the headaches.
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Answer from: at Academic Institution
In my opinion, the best approach is premedication with steroids and/or NSAIDs. If that does not work, consider whether it is an immune-mediated headache (will start a few days later and can last days to a week). Another option is to switch to subcutaneous IG and patients may have no headache or mild...
Answer from: at Academic Institution
If NSAIDs are ineffective, you can do a short course of steroids. I use prednisone 10-20mg for 1-3 days starting the day before the headache usually starts, if it is very predictable.
Answer from: at Academic Institution
Steroids and NSAIDs work well.
Have a low threshold for MR or CT venogram of the head as severe non responsive headaches may be a sign of cerebral venous sinus thrombosis.