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Abstract Details

Polypharmacy and Trends in Pharmacologic Management in Patients with Refractory Spontaneous Intracranial Hypotension (SIH)
Headache
P2 - Poster Session 2 (8:00 AM-9:00 AM)
12-007
To investigate polypharmacy and trends in pharmacologic management in patients with refractory spontaneous intracranial hypotension (SIH). 
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. 
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. 
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.  
Medication trials for refractory SIH may contribute to polypharmacy in a subset of patients. Further investigation into the impact of polypharmacy in SIH patients is warranted. 
Authors/Disclosures
Adora Zhang
PRESENTER 		Ms. Zhang has nothing to disclose.
Arashleen K. Pannu Ms. Pannu has nothing to disclose.
Divya Polu Ms. Polu has nothing to disclose.
Naomi Doshi Ms. Doshi has nothing to disclose.
Ahmed Taha Shahzad Mr. Shahzad has nothing to disclose.
Justin Nofar, MD Dr. Nofar has nothing to disclose.
Victor Wang, MD (Thomas Jefferson University Hospital) Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Wang has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center) An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.
Simy K. Parikh, MD Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Parikh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Touch Independent Medical 好色先生 (touchIME) . Dr. Parikh has a non-compensated relationship as a Medical Advisory Board Member with Spinal CSF Leak Foundation that is relevant to AAN interests or activities.