Headache in transplant patients

Jennifer Robblee MD MSc FRCPC (

Dr. Robblee of Barrow Neurological Institute has no relevant financial relationships to disclose.

)
Shuu-Jiun Wang MD, editor. (

Dr. Wang of the Brain Research Center, National Yang-Ming University, and the Neurological Institute, Taipei Veterans General Hospital, received consulting fees from Eli Lilly, Daichi-Sankyo, and Novartis.

)
Originally released December 10, 2003; last updated August 29, 2019; expires August 29, 2022

This article includes discussion of headache in transplant patients, primary headache disorders, secondary headache disorders, headache attributed to long-term use of nonheadache medication, headache attributed to infection, headache attributed to nontraumatic intracranial hemorrhage, posterior reversible encephalopathy syndrome (PRES), and idiopathic intracranial hypertension. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

This article discusses the approach to headache when presenting in the context of solid organ or hematopoietic stem cell transplant patients, which can include both primary and secondary causes. In this article, the author outlines the epidemiology and etiologies of headache in the transplant population including pharmacotherapies, infection, vascular associations, and miscellaneous causes. Suggestions for management and possible pathophysiological mechanisms are discussed.

Key points

 

• Headache, which can significantly affect quality of life, is common in patients who have received transplants.

 

• As in the general population, the most common headaches seen in transplant patients are migraine and tension-type headache.

 

• The best characterized secondary cause of headache in patients who have received transplants is the usage of immunosuppressants such as cyclosporine and tacrolimus.

 

• Other most important differential diagnoses are infection and intracerebral hemorrhage.

Historical note and terminology

Organ transplantation is 1 of the greatest therapeutic advancements of the second half of the 20th century. Transplants are defined as tissue, including an organ or group of cells, being transferred from a donor to a recipient. They can include solid organ transplantation like a liver or heart but can also include hematopoietic stem cell transplants often used in the treatment of cancer.

Organ transplantation was first referred to in Hindu texts around 3000 BC with skin autografting (Linden 2009). The first successful human transplant was kidney transplantation between twins in 1954. In 1962 azathioprine started being used for immunosuppression, but over time due to persistent morbidity and mortality other agents were tried.

By 1983, the triple therapy of cyclosporine, azathioprine, and corticosteroids became the preferred therapy for allograft transplantation. Since that time, further innovations in immunosuppression have included agents such as tacrolimus, mycophenolate, sirolimus, and others.

The concept of headache in transplant patients does not have a clear history and in general is poorly documented in terms of clinical features. There are multiple etiologies that can be identified including many secondary causes. It is known that headache can significantly impact the quality of life in patients with history of transplant. The association between headaches and transplant patients is not well understood and more clinical studies are needed.

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