SUCCESSFUL TREATMENT OF HEADACHE RELATED TO INTRAVENOUS IMMUNOGLOBULIN WITH ANTIMIGRAINE MEDICATIONS

In order to investigate headache related to intravenous immunoglobulin , we studied a 36-year-old woman with a history of migraine receiving weekly intravenous immunoglobulin for refractory myasthenia gravis who experienced severe headaches with each treatment. Neurological examin ation. CT scan of the head, and a lumbar puncture after the first head ache were normal. Significant therapeutic response was based upon 50% reduction in pain and associated features. Headache features included throbbing pain which worsened with head movement and was associated wi th severe photophobia and nausea. Sumatriptan, 6 mg subcutaneous, redu ced headache significantly with resolution of associated complaints. T reatment prior to intravenous immunoglobulin with dihydroergotamine me sylate resulted in development of only a mild dull ache without furthe r development of severe head pain. Dihydroergotamine mesylate was also abortive in the few instances when the headache worsened. Headaches a ssociated with intravenous immunoglobulin may have features of migrain e and may be successfully prevented and/or treated with 5-HT1D recepto r agonists.