Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review

ABSTRACT

Background

While systematic reviews have examined medication effectiveness for post-traumatic headache (PTH), they have not assessed tolerability.

Objective

To conduct a scoping review to characterize the adverse effects of pharmacotherapy for PTH.

Methods

CINAHL, CMA Infobase, Cochrane Library, Embase, Epistemonikos, MEDLINE, PEDro, PsycInfo, Scopus, SportDiscus, TRIP and the University of York Center for Reviews and Dissemination were searched. Studies meeting these criteria were included 1) English language, 2) involved humans with traumatic brain injury (TBI), 3) a medication for PTH was administered and 4) reported tolerability outcomes. Author(s), publication year, country of origin, study design, sample demographics, medication type, comparator, dose, treatment duration, adverse effect type and rate, discontinuation rate, and effectiveness outcomes were extracted.

Results

The search yielded 2941 records; 11 studies were included (n = 324 subjects). All subjects had mild TBI except for one with moderate TBI. The following therapies were examined 1) abortive (dihydroergotamine N = 1; metoclopramide N = 1; indomethacin N = 3), 2) prophylactic (divalproex sodium N = 1; amantadine N = 1; erenumab N = 2; amitriptyline N = 2). No serious adverse effects occurred. Observed adverse effects overlap with common symptoms of TBI.

Conclusion

The unique needs of people with TBI must be considered when instituting pharmacotherapy. More studies specifically evaluating medication tolerability in PTH are needed.

KEYWORDS:

• Traumatic brain injuries
• Post-Traumatic headache
• drug therapy
• Drug-Related side effects and adverse reactions

Disclosure of Interest

The authors declare that there is no conflict of interest regarding the publication of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2023.2165156

Additional information

Funding

As a Vanier Scholar, Amanda McIntyre is supported by the Government of Canada, Vanier Canada Graduate Scholarships.The author(s) reported that there is no funding associated with the work featured in this article.