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IVIg-induced headache: prospective study of a large cohort with neurological disorders

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Abstract

Background

Intravenous immune globulin (IVIg) is frequently used in some neurological diseases and is also the first-line therapy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. We aimed to evaluate the frequency and characteristics of headaches, which is one of the most common side effects of IVIg treatment.

Methods

Patients who received IVIg treatment for neurological diseases were prospectively enrolled in 23 centers. Firstly, the characteristics of patients with and without IVIg-induced headaches were analyzed statistically. Then, patients with IVIg-induced headaches were classified into three subgroups determined by their history: no primary headache, tension-type headache (TTH), and migraine.

Results

A total of 464 patients (214 women) and 1548 IVIg infusions were enrolled between January and August 2022. The frequency of IVIg-related headaches was 27.37% (127/464). A binary logistic regression analysis performed with significant clinical features disclosed that female sex and fatigue as a side effect were statistically more common in the IVIg-induced headache group. IVIg-related headache duration was long and affected daily living activities more in patients with migraine compared to no primary headache and TTH groups (p = 0.01, respectively).

Conclusion

Headache is more likely to occur in female patients receiving IVIg and those who develop fatigue as a side effect during the infusion. Clinicians’ awareness of IVIg-related headache characteristics, especially in patients with migraine, may increase treatment compliance.

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Abbreviations

CIDP:

Chronic inflammatory demyelinating polyneuropathy

GBS:

Guillain-Barré syndrome

ICHD-3:

International Classification for Headache Disorders, 3rd edition

IVIg:

Intravenous immune globulin

MG:

Myasthenia gravis

MMN:

Multifocal motor neuropathy

MS:

Multiple sclerosis

NSAIDs:

Non-steroidal anti-inflammatory drugs

PRES:

Posterior reversible encephalopathy syndrome

SC:

Subcutaneous

TTH:

Tension-type headache

VAS:

Visual Analog Scale

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Acknowledgements

Thanks to Ebru Nur Vanlı Yavuz and Ahmet Zihni Soyata for statistical evaluation and Serkan Aksu for editing and revising the manuscript. We thank the Global Migraine and Pain Society for their support in data collection.

Study Group:

1. Ayla Çulha Oktar

Department of Neurology, MD, Haseki Training and Research Hospital, Istanbul, Turkey.

2. Ferda İlgen Uslu

Department of Neurology, Assoc. Prof Dr., Bezmialem University, Faculty of Medicine, Istanbul, Turkey

3. Nevra Öksüz

Department of Neurology, MD, Mersin University, Faculty of Medicine, Mersin, Turkey

4. Nazan Karagöz Sakallı

Department of Neurology, MD, Prof. Dr. Bakırkoy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey.

5. Belgin Munise Mutluay

Department of Neurology, MD, Prof. Dr. Bakırkoy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey

6. Pınar Bekdik

Department of Neurology, MD, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey

7. Dr. Zeynep Vildan Okudan Atay

Department of Neurology, MD, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

Author information

Authors and Affiliations

  1. Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

    Buse Rahime Hasırcı Bayır & Ezgi Nazlı

  2. Department of Neurology, Istanbul Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey

    Miraç Ayşen Ünsal

  3. Department of Neurology, Dokuz Eylül University, Izmir, Turkey

    Cansu Ağırcan

  4. Department of Neurology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Tuba Cerrahoğlu Şirin

  5. Department of Neurology, Cemil Tascıoglu City Hospital, Istanbul, Turkey

    Onur Akan

  6. Department of Neurology, Umraniye Training and Research Hospital, Istanbul, Turkey

    Gizem Gürsoy

  7. Department of Neurology, Bagcılar Training and Research Hospital, Istanbul, Turkey

    Tuğba Eyigürbüz

  8. Department of Neurology, Istanbul Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey

    Dilara Mermi Dibek, Ayşe Deniz Elmalı & Şule Deveci

  9. Department of Neurology, Kutahya Health Sciences University, Kutahya, Turkey

    Gönül Akdağ & Fatma Akkoyun Arıkan

  10. Department of Neurology, Bakırkoy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey

    Sezin Alpaydın Baslo

  11. Department of Neurology, Faculty of Medicine, Harran University, Urfa, Turkey

    Dilek Ağırcan & Tülin Gesoğlu Demir

  12. Department of Neurology, Faculty of Medicine, Uludag University, Bursa, Turkey

    Emel Oguz-Akarsu & Necdet Karlı

  13. Department of Neurology, Sancaktepe Şehit İlhan Varank Training and Research Hospital, Istanbul, Turkey

    Özdem Ertürk Çetin

  14. Department of Neurology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey

    Esra Acıman Demirel

  15. Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey

    Doğa Vurallı

  16. Department of Neurology, Malatya Training and Research Hospital, Malatya, Turkey

    Tuba Tanyel

  17. Department of Neurology, Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey

    Füsun Mayda Domaç

  18. Department of Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

    Sibel Velioğlu

  19. Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Betül Baykan

Authors
  1. Buse Rahime Hasırcı Bayır
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  2. Miraç Ayşen Ünsal
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  3. Cansu Ağırcan
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  13. Sezin Alpaydın Baslo
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  14. Dilek Ağırcan
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  25. Betül Baykan
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Consortia

Study Group

  • Ayla Çulha Oktar
  • , Ferda İlgen Uslu
  • , Nevra Öksüz
  • , Nazan Karagöz Sakallı
  • , Belgin Munise Mutluay
  • , Pınar Bekdik
  •  & Zeynep Vildan Okudan Atay

Corresponding author

Correspondence to Buse Rahime Hasırcı Bayır.

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The study has ethical approval. Informed consent was obtained from all patients.

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Hasırcı Bayır, B.R., Ünsal, M.A., Ağırcan, C. et al. IVIg-induced headache: prospective study of a large cohort with neurological disorders. Neurol Sci 44, 2871–2881 (2023). https://doi.org/10.1007/s10072-023-06731-x

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