Objective:

To investigate polypharmacy and trends in pharmacologic management in patients with refractory spontaneous intracranial hypotension (SIH). 

Background:

SIH is a headache disorder caused by cerebrospinal fluid leak. Treatments range from conservative to invasive therapies (e.g., epidural blood patching). For patients with SIH refractory to traditional therapies, treatment can involve multiple classes of migraine medications, which increases the risk of polypharmacy, the simultaneous use of ≥5 medications. Polypharmacy can increase the risk of drug toxicity, adverse events, and treatment nonadherence. 

Design/Methods:

This is a subanalysis of an IRB-approved, retrospective chart review (IRB #22D.519) of electronic medical records of 41 patients aged ≥ 18 evaluated at a tertiary headache center by one SIH specialist from January 1, 2021 to September 1, 2023 who met Schievink 2011 criteria for SIH diagnosis. Records were reviewed for migraine medications used before and up to 18 months after patients’ initial visit. Prescription medications were categorized by class: triptans, dihydroergotamines, anti-CGRP monoclonal antibodies, CGRP antagonists, NSAIDs, antidepressants, antihypertensives, and anticonvulsants. 

Results:

30 patients met inclusion criteria. 26 followed up at 0-3 months, 19 at 3-6 months, and 15 at 6-12months. Patients trialed an average of 2.97 ± 2.17 medication classes before their initial visit. On average, patients were taking 0.83 ± 1.26 classes concurrently at their initial visit, and then 1.87 ± 1.96 , 1.67 ± 1.96, and 1.3 ± 1.99 classes concurrently at 0-3, 3-6, and 6-12 month follow-ups, respectively. At the first visit, 13.3% were taking ≥5 classes concurrently, compared to 19.2% at 0-3 months, 21.1% at 3-6 months, and 20.0% at 6-12 months.  

Conclusions: