1. Factors associated with headache in intravenous immunoglobulin treatment for neurological diseases
- Author
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Orhan Aktas, Jens Ingwersen, Hans-Peter Hartung, Jonas Graf, Marius Ringelstein, Philipp Albrecht, and Klaudia Lepka
- Subjects
Adult ,Male ,Time Factors ,Blood Pressure ,03 medical and health sciences ,0302 clinical medicine ,Natalizumab ,Sex Factors ,Cephalalgia ,Heart Rate ,Risk Factors ,Vasoactive ,Heart rate ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Infusions, Intravenous ,book ,Aged ,Retrospective Studies ,book.periodical ,biology ,business.industry ,Incidence (epidemiology) ,Headache ,Immunoglobulins, Intravenous ,General Medicine ,Middle Aged ,Blood pressure ,Treatment Outcome ,Neurology ,Anesthesia ,biology.protein ,Female ,Neurology (clinical) ,Antibody ,Nervous System Diseases ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Objectives To identify possible risk factors influencing the incidence of intravenous immunoglobulin (IVIg) treatment-related cephalalgia in neurological diseases. Materials & methods Retrospective chart review of neurological patients receiving IVIg treatment between July 13, 2017, and August 14, 2017. Patients with MS receiving natalizumab in the same setting were observed as a reference group. Results Patients with headache after IVIg infusion (n = 22 infusions) showed a reduced heart rate (by 6.0 ± 8.5 beats per minute [bpm]), but no significant difference in blood pressure. Patients without headache after IVIg infusion (n = 69 infusions) showed a higher systolic blood pressure increase and a stronger reduction in the heart rate (by 5.7 ± 8.6 bpm), compared to patients with headache after IVIg infusion. The infusion rate was significantly slower and age significantly lower in patients developing headache after IVIg infusion. Body temperature was unchanged in both groups. Binary logistic regression analysis revealed that blood pressure at baseline and age significantly influence the occurrence of cephalalgia. In reference, patients receiving natalizumab (ie, shorter infusions/smaller infusion volume), systolic blood pressure, and heart rate decreased, while body temperature increased. Here, one patient developed headache. Conclusions Intravenous immunoglobulin-associated headache is not associated with an increased blood pressure after infusion but with a reduced heart rate, a slower infusion rate, female sex and seems to be influenced by baseline systolic blood pressure and age. A reaction to immunoglobulin aggregates, stabilizers, or vasoactive mediators are possible explanations. The absence of an association with body temperature does not suggest a systemic immune response as a cause for headache.
- Published
- 2019