Safety of select headache medications in patients with cerebral and spinal cavernous malformations

Background: Patients with cerebral or spinal cavernous malformations (CM) and a primary headache disorder are often limited in medication options due to concern for bleeding risk. Methods: From a prospective cohort of CM patients (2015–2020), demographics, mode of clinical presentation, and radiogra...

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Autores principales:	Kelly D Flemming, Chia-Chun Chiang, Robert D Brown, Giuseppe Lanzino
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Therapeutics. Pharmacology RM1-950 Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/b21a73610f424736881bbc0f1d1940ac
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spelling	oai:doaj.org-article:b21a73610f424736881bbc0f1d1940ac2021-11-30T23:34:03ZSafety of select headache medications in patients with cerebral and spinal cavernous malformations2515-816310.1177/25158163211062254https://doaj.org/article/b21a73610f424736881bbc0f1d1940ac2021-11-01T00:00:00Zhttps://doi.org/10.1177/25158163211062254https://doaj.org/toc/2515-8163Background: Patients with cerebral or spinal cavernous malformations (CM) and a primary headache disorder are often limited in medication options due to concern for bleeding risk. Methods: From a prospective cohort of CM patients (2015–2020), demographics, mode of clinical presentation, and radiographic data were collected. Follow up of patients was performed with electronic medical record review, in person visits and/or written surveys. Select medication use was ascertained from the time of the CM diagnosis to a censor date of first prospective symptomatic hemorrhage, complete surgical excision of sporadic form CM, or death. The influence of non-aspirin NSAID (NA-NSAID), triptan, or OnabotulinumtoxinA on prospective hemorrhage risk was assessed. Results: As of August 20, 2020, 329 patients with spinal or cerebral CM (58% female; 20.1% familial; 42.2% initial presentation due to hemorrhage; 27.4% brainstem) were included. During a follow-up of 1799.9 patient years, 92 prospective hemorrhages occurred. Use of NA-NSAIDs, triptans, and OnabotulinumtoxinA after the diagnosis of CM was unassociated with an increased risk of prospective hemorrhage. Conclusions: Use of triptans and NA-NSAIDs, does not precipitate CM hemorrhage. Similarly, we did not find that OnabotulinumtoxinA precipitated CM hemorrhage in a limited number of patients at doses <200 units per session.Kelly D FlemmingChia-Chun ChiangRobert D BrownGiuseppe LanzinoSAGE PublishingarticleTherapeutics. PharmacologyRM1-950Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENCephalalgia Reports, Vol 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950 Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	Therapeutics. Pharmacology RM1-950 Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Kelly D Flemming Chia-Chun Chiang Robert D Brown Giuseppe Lanzino Safety of select headache medications in patients with cerebral and spinal cavernous malformations
description	Background: Patients with cerebral or spinal cavernous malformations (CM) and a primary headache disorder are often limited in medication options due to concern for bleeding risk. Methods: From a prospective cohort of CM patients (2015–2020), demographics, mode of clinical presentation, and radiographic data were collected. Follow up of patients was performed with electronic medical record review, in person visits and/or written surveys. Select medication use was ascertained from the time of the CM diagnosis to a censor date of first prospective symptomatic hemorrhage, complete surgical excision of sporadic form CM, or death. The influence of non-aspirin NSAID (NA-NSAID), triptan, or OnabotulinumtoxinA on prospective hemorrhage risk was assessed. Results: As of August 20, 2020, 329 patients with spinal or cerebral CM (58% female; 20.1% familial; 42.2% initial presentation due to hemorrhage; 27.4% brainstem) were included. During a follow-up of 1799.9 patient years, 92 prospective hemorrhages occurred. Use of NA-NSAIDs, triptans, and OnabotulinumtoxinA after the diagnosis of CM was unassociated with an increased risk of prospective hemorrhage. Conclusions: Use of triptans and NA-NSAIDs, does not precipitate CM hemorrhage. Similarly, we did not find that OnabotulinumtoxinA precipitated CM hemorrhage in a limited number of patients at doses <200 units per session.
format	article
author	Kelly D Flemming Chia-Chun Chiang Robert D Brown Giuseppe Lanzino
author_facet	Kelly D Flemming Chia-Chun Chiang Robert D Brown Giuseppe Lanzino
author_sort	Kelly D Flemming
title	Safety of select headache medications in patients with cerebral and spinal cavernous malformations
title_short	Safety of select headache medications in patients with cerebral and spinal cavernous malformations
title_full	Safety of select headache medications in patients with cerebral and spinal cavernous malformations
title_fullStr	Safety of select headache medications in patients with cerebral and spinal cavernous malformations
title_full_unstemmed	Safety of select headache medications in patients with cerebral and spinal cavernous malformations
title_sort	safety of select headache medications in patients with cerebral and spinal cavernous malformations
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/b21a73610f424736881bbc0f1d1940ac
work_keys_str_mv	AT kellydflemming safetyofselectheadachemedicationsinpatientswithcerebralandspinalcavernousmalformations AT chiachunchiang safetyofselectheadachemedicationsinpatientswithcerebralandspinalcavernousmalformations AT robertdbrown safetyofselectheadachemedicationsinpatientswithcerebralandspinalcavernousmalformations AT giuseppelanzino safetyofselectheadachemedicationsinpatientswithcerebralandspinalcavernousmalformations
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Safety of select headache medications in patients with cerebral and spinal cavernous malformations

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