Headaches

The majority of the liver allograft recipients taking cyclosporine have problems with headaches. These headaches are usually bitemporal and slowly respond to minor analgesics such as aspirin or acetaminophen. Most of these episodes of headaches are a dose-related side effect of cyclosporine. We usually check the 12 hour trough (HPLC) level of cyclosporine, and if it is above low "therapeutic" levels (i.e., above 90 to 150) we lower the daily dosage by 10% weekly until the headaches stop or a dosage of 2-3 mg/kg per day is reached. This rather aggressive reduction of cyclosporine is safely done after six month following liver transplantation, or with serial allograft biopsies (i.e biopsy directed immunosuppression).  For resistant headaches, Fiorinal with and without Elavil have occasionally been helpful.