Medication Headaches

Many drugs can induce acute headache, including nitroglycerin, antihypertensive agents (beta blockers, calcium channel blockers, angiotensin-converting enzyme [ACE] inhibitors, and methyldopa), dipyridamole, hydralazine, sildenafil, histamine receptor antagonists (e.g., cimetidine and ranitidine), NSAIDs (especially indomethacin), cyclosporine, and antibiotics (especially amphotericin, griseofulvin, tetracycline, and sulfonamides).

Drug-induced aseptic meningitis, a rare occurrence, has numerous possible causes, including NSAIDs, antibiotics (e.g., trimethoprim-sulfamethoxazole, sulfasalazine, cephalosporins, ciprofloxacin, isoniazid, and penicillin), intrathecal drugs and diagnostics (e.g., antineoplastic agents such as methotrexate and cytarabine; gentamicin; corticosteroids; spinal anesthesia; baclofen; repeated iophendylate for myelography; and radiolabeled albumin); intraventricular chemotherapy; intravenous immunoglobulin; vaccines (polio; measles, mumps, and rubella; and hepatitis B); and some other drugs, such as carbamazepine, muromonab-CD3, and ranitidine.⁴³

The clinical presentation of drug-induced aseptic meningitis is the same as that of viral meningitis. Cerebrospinal fluid findings are the same as those in viral meningitis, except for a neutrophil predominance; however, in cases induced by intravenous immunoglobulin, eosinophils are present.