Thalidomide-Related Headache

mean time of 3 months (range 1–4 months) after the start of thalidomide treatment. Regarding the 4 remaining patients, headache occurred after a mean time of 7 months (range 1–14.5 months). In most cases, it was tension-type headache; only 1 patient suffered from migraine with visual aura. Neuroimaging was performed in all patients to exclude symptomatic forms of headache (neurolupus, thrombosis, ...) and was normal. A dose reduction was performed in 6 patients, with a partial (5 cases) or complete (1 case) improvement of headache. Treatment continuation was then possible in 3 of the 5 partially improved patients. Thalidomide was interrupted in 4 cases (2 for complete remission of the underlying disease and 2 for unbearable headache), without relapse of the headache after a mean follow-up of 8 months. One patient was rechallenged with thalidomide and reexperienced headache. Our cases suggest that thalidomide may induce headache (compatible chronology, improvement after discontinuation, positive rechallenge) which can limit its use. Its management should be based on dose adjustment or temporary interruption of the drug, as analgesics are not sufficient in most cases. There seems to exist an individual dose-dependent effect. If maintenance of the therapy is necessary, the minimal effective dose should be given.