SAN DIEGO, CA, May 09 (Reuters Health) - The headache that frequently occurs with interferon beta therapy for multiple sclerosis (MS) has been identified as migraine, according to research presented here at the 52nd annual meeting of the American Academy of Neurology.
"While up to 75% of patients on interferon beta therapy for MS develop flu-like symptoms, including headache, interferon beta has not been confirmed as a trigger for migraine attacks, and the headache associated with its use has been variably and vaguely characterized," Dr. Jan Lewis Brandes, of Nashville Neuroscience Group, in Tennessee, explained during a poster presentation.
Therefore, Dr. Brandes conducted a study in which 51 MS patients receiving interferon beta for chronic immunomodulation were evaluated for preexisting migraine or other benign headache disorders. After the start of interferon beta treatment, the subjects were followed for subsequent headache episodes, which were classified on the basis of International Headache Society (IHS) criteria and their temporal association with interferon beta injection.
The study patients were offered mini-prophylaxis with non-steroidal anti-inflammatory agents (NSAIDs) or migraine-specific 5-HT agonists. Rescue instructions were given for headache recurrence. On the mini-prophylaxis regimen, patients took the medication 6 to 12 hours before interferon beta injection with repeat dosing at the time of injection and again within 2 to 6 hours after injection.
Otherwise, patients opted to treat their headache abortively at the start of symptoms. Each patient treated at least five attacks with this regimen.
Overall, 10 patients described interferon beta therapy as a consistent trigger for their headaches, and their symptoms satisfied IHS criteria for migraine with or without aura. Of these patients, only one was an established migraineur. Nine patients reported the onset of recurrent attacks after the start of interferon treatment. Combination therapy with high-dose NSAIDs and triptans was most effective in decreasing migraine occurrence and severity.
Dr. Brandes urges clinicians to be alert to the potential for migraines
in MS patients receiving interferon beta therapy and to consider aggressive
migraine-specific treatments in this population.