Inpatient infusion treatments of headache in patients with chronic migraine and a reported history of head trauma and endocrine co-morbidities

Abstract

To evaluate if inpatient infusion treatments for patients with chronic migraine (CM) and history of head trauma and endocrine abnormalities can lead to headache improvement. Many patients with CM and history of head trauma have endocrine co-morbidities that can interfere with successful management of headache. In this study, we evaluated if inpatient infusion treatments improved headache outcomes for this patient population. Retrospective chart review of patients admitted and treated with 4-5 days of intravenous (IV) Dihydroergotamine (DHE), Chlorpromazine, or Valproate for headache. All cases were presented at the Headache Center Case Conference before admission, and plans for addressing co-morbidities were discussed with appropriate specialists and primary care providers. Co-morbidities addressed included diabetes mellitus, pituitary and thyroid dysfunction and endometriosis. During admission, vital signs and appropriate lab work such as serum glucose, thyroid, liver and renal function were monitored. Lifestyle recommendations provided during admission and appropriate follow ups after discharge were arranged with Headache Clinic, primary care, and specialists, when applicable. 53 patients with CM were included in the analysis. 12 (22.6%) of the 53 patients had both reported history of head trauma and endocrine comorbidity. Of these 12 patients, 8 (66.7%) had improvement in headache up to 6 weeks after admission. Of the 8 that improved, 6 (75%) received DHE and 2 (25%) received Chlorpromazine. Inpatient infusion treatments for patients who have CM with history of head trauma and endocrine abnormalities can lead to headache improvement, potentially due to IV infusion therapy along with holistic approaches which include addressing co-morbidities and education on lifestyle modifications. Future studies are needed to evaluate if specific endocrine system dysfunction can predict outcomes from repetitive infusion therapy for persistent headache in patients with CM and a reported history of head trauma.