Tips for Dealing With IVIG Headaches

Do you experience headaches during or after IVIG Infusions? If so, you are not alone. IVIG infusions can cause very painful and long-lasting headaches in some individuals.

Frequently, an immediate reaction to IVIG is observed. Headache, nausea, myalgia, fever, and chills are the most common adverse reactions, and they often occur immediately, during, or after the infusion. The severity of delayed events such as migraine headaches and aseptic meningitis may increase over time. Patients who have or recently had a bacterial infection or underlying chronic inflammation are more likely to experience these adverse reactions. 

According to a survey by the Immune Deficiency Foundation, 34% of reactions occurred during the initial IVIG infusion and decreased with subsequent infusions. Although rare, severe events can include hemolysis, renal impairment, and thrombotic events. Among the most common adverse effects up to 24 hours after an infusion are headaches, which can occur for a variety of reasons. 

In this article, we will provide advice on how to prevent or alleviate headaches caused by IVIG, based on actual patient experiences.

Hydration Before and After IVIG

Hydration is crucial when undergoing IVIG therapy. Beginning the day before and continuing through the day after an IVIG infusion, drink water throughout the day. 

Diplomat Specialty Infusion Group’s Vicky Starr suggests alternating water and a caffeinated beverage, such as green tea, if you can tolerate caffeine. It is essential to continue drinking water and your caffeinated beverage on the day of your infusion and the day after. 

IV Fluid Addition

The addition of intravenous (IV) fluids on the day of your infusion is another method for obtaining additional hydration. Some patients receive a bag of fluids prior to the infusion, others at the conclusion, and still others both before and after the infusion. 

Premedications

Before an infusion, Benadryl is frequently administered as a premedication by the infusion nurse or taken by the patient at home. However, Benadryl, which is an antihistamine available without a prescription, is not effective for everyone.

If you continue to experience headaches, discuss with your doctor the possibility of switching from Benadryl to cyproheptadine (also known as Periactin). Cyproheptadine is a serotonin receptor antagonist and antihistamine that is particularly effective for plasma and blood reactions.

Pretreatment with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (15 mg/kg/dose), and a nonsedating antihistamine (such as Cetirizine 10 mg) one hour prior to the infusion may help prevent adverse reactions. Hydrocortisone (6 mg/kg/dose, with a maximum of 100 mg) may also be considered.

Switching to a 5% IVIG preparation is frequently highly effective if the symptoms reappear. Caution is advised when switching IVIG products because 15% to 18% of patients experience serious adverse reactions during the process.

The majority of physicians favor subcutaneous immunoglobulin (SCIG) over IVIG for most patients and may encourage making a transition. Transitioning to SCIG reduces the risk and severity of common and more serious side effects. Therefore, transitioning to SCIG is an option for IVIG patients who experience severe headaches.