Ask Dr. Stephan Moll

These questions have been submitted by folks on the mailing list and answered by Dr. Moll, Director of the Thrombophilia Program at the Carolina Cardiovascular Biology Center, Department of Medicine, Division of Hematology-Oncology, UNC Chapel Hill (North Carolina, USA). Why am I doing this?

10. Headaches and heparin

Q: "I am 44 years old and recently had a DVT. I had never suffered from headaches, but within a couple of hours of starting heparin I started to have the worst headache imaginable. I needed Morphine and other narcotics to get some relief. I had it all day long for several days because they kept me on i.v. heparin. My doctors ordered several head CTs and MRIs to make sure I didn't have a bleed into my head. I didn't. They finally tried Ergotamine, a medication they give for migraine, and the pain went away completely. All doctors, except for a senior hematologist, said they had never seen that with heparin. It must be very rare. Interestingly, I also had Lovenox at some point, which they say is a type of heparin, but that didn't give me any headaches. Have you ever heard of such a case?"

A: This is the first case of severe heparin-headaches I have encountered.

Even though "headaches" are listed as one of the possible side effects of heparin in pharmacology textbooks, severe headaches requiring high doses of narcotics have, to my knowledge, not been reported in the medical literature. Severe headaches may be due to a bleed into the head or due to a clot in the veins draining the brain tissue (= sinus vein thrombosis), and this is a great concern in patients who develop headaches while on blood thinners. However, CTs and MRIs ruled out a bleed or clot in the above patient. The fact that these headaches responded to Ergotamine, a medication that leads to narrowing of the blood vessels, suggests that these heparin-headaches were due to vasodilatation (temporary widening of the blood vessels) with overstretching of the nerve fibers within the blood vessel wall. Why that should have occurred with heparin is not clear to me.

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