Medication Triggers in Autoimmune Migraineurs
Last updated: September 2023
Autoimmunity has been estimated to be the second leading cause of illness. Migraine is very common in those of us with autoimmunity. So are other headache disorders. There are many reasons why this is the case. One of them is triggers that relate particularly to those undergoing treatment for their autoimmunity.
What is autoimmunity? Autoimmunity is a disorder of the immune system that results in the body targeting and destroying healthy cells (self) instead of invaders like bacteria and viruses. Some common examples of autoimmune diseases are :
- Lupus (antibodies attack connective tissues)
- Sjogren’s Syndrome (antibodies attack exocrine glands)
- Rheumatoid Arthritis (antibodies attack the joints)
- Hashimoto’s Thyroiditis (antibodies attack the thyroid)
- Graves’ Disease (antibodies stimulate TSH receptors in the thyroid)
Sometimes treatment of the underlying autoimmune disease will help the patient’s headaches or Migraine attacks. Unfortunately, it doesn’t always work that easily though. Sometimes the treatment medications themselves can trigger Migraine and other headaches. These medicines are often chemotherapy drugs and can include:
** Azathioprine (Azasan, Imuran) — triggers from this drug can include anemia, nausea resulting in eating changes, malabsorption and vitamin/mineral deficiencies
** Benlysta (Belimumab) - Headache (Migraine) is listed as one of the most common side effects of this newly approved lupus medication.
** Cyclophosphamide (Cytoxan) — triggers can include anemia, nausea and diarrhea which results in eating changes, malabsorption and vitamin/mineral depletion. Migraineurs are often deficient in Magnesium. Patients who are magnesiuim deficient may have particular trouble with other adverse reactions with this medication
** Cyclosporin — triggers can include depleted magnesium levels, vomiting resulting in altered eating patterns, malabsorption and vitamin/mineral depletion.
** IVIG infusions are strongly linked to Migraine attacks which can be severe, intractable and last for several days. A very slow rate of infusion and pre-treatment with IV Benadryl and oral acetaminophen or other pain medication is sometimes helpful. IVIG treatment can cause inflammation which itself can act as a Migraine trigger. Aseptic meningitis incidence is higher in Migraineurs using this treatment.
** Methotrexate — triggers can include magnesium depletion, and a depletion of folic acid levels. Methotrexate can sometimes increase to toxic levels causing symptoms like hyperosmia (increased sensitivity to smell) that may act as a Migraine trigger.
** NSAIDs, Opiates and other pain medications which may be necessary if the autoimmune condition is severe. This is a frequent cause of Migraine rebound/ Medication Overuse Headache (MOH) in autoimmune patients. The result is a no-win situation in which the patient's daily and sometimes very severe pain is often left untreated.
** Plaquenil — triggers from this medicine can include neurological problems, problems with eyesight, increased photosensitivity, anemia, nausea leading to eating changes.
Note: Treatment with steroids can be very beneficial for both Migraineurs and autoimmune patients in the short run, but the side effect profile risk of long term usage sadly often outweighs those benefits.
More information can be found here: Migraine Triggers for the Autoimmune Patient
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