Can Eliquis Cause Headaches?
Yes, Eliquis (apixaban) can cause headaches, though the FDA label does not explicitly list headache as a common side effect, stating only that patients should "tell your doctor if you have any side effect that bothers you or that does not go away." 111
Clinical Evidence of Headache Association
While the official FDA labeling for Eliquis does not prominently feature headache as a documented adverse effect, emerging clinical case reports suggest a potential link, particularly in patients with underlying migraine disorders:
A 2023 case report documented a 45-year-old male with longstanding migraine with aura who experienced a significant increase in both frequency and severity of migraine attacks shortly after starting apixaban 2. The patient's symptoms persisted for 7 months while on the medication and returned to baseline "almost immediately" after discontinuation, suggesting a direct causal relationship.
A 2017 case report described a 55-year-old female who had complete remission of migraine with aura for 12 years on warfarin, but experienced return of symptoms within 3 weeks of switching to apixaban 3. Her symptoms resolved again within days of resuming warfarin, indicating that apixaban specifically—rather than anticoagulation in general—may trigger or worsen migraine in susceptible individuals.
Important Clinical Considerations
The most critical headache concern with Eliquis is not routine headache, but rather headache as a warning sign of intracranial bleeding, which is a serious and potentially fatal complication. The FDA label explicitly warns: "Call your doctor or get medical help right away if you have... headaches, feeling dizzy or weak" as these may indicate bleeding complications 1.
When to Be Concerned About Headaches on Eliquis:
- Severe or sudden-onset headache (potential intracranial hemorrhage)
- Headache accompanied by dizziness, weakness, or confusion
- Headache after head trauma or falls (the label specifically warns to contact your doctor if you fall or hit your head) 1
- Progressive worsening of pre-existing migraine pattern (as documented in case reports)
Clinical Recommendations
For patients on Eliquis reporting new or worsening headaches:
- First, rule out bleeding complications through careful neurological examination and appropriate imaging if red flags are present
- Assess the temporal relationship between Eliquis initiation and headache onset
- In patients with pre-existing migraine disease, consider that apixaban may worsen migraine frequency and severity based on available case reports 23
- If headaches are persistent and bothersome, discuss with the prescribing physician as the FDA label advises 11
Common Pitfall to Avoid:
Do not dismiss new headaches in anticoagulated patients as benign without proper evaluation. While routine headaches may occur, the bleeding risk with anticoagulants necessitates a lower threshold for investigation, particularly if headaches are severe, sudden, or associated with neurological symptoms.
The evidence base for routine headaches as a side effect of apixaban remains limited to case reports, but the documented cases of migraine exacerbation are compelling enough to warrant consideration in susceptible patients 23.