Can tranexamic acid (TXA) cause headaches?

Tranexamic Acid and Headache

Headache is a recognized side effect of tranexamic acid (TXA), as documented in the FDA drug label, and should be monitored in patients receiving this medication. 1

Mechanism and Evidence

Tranexamic acid is an antifibrinolytic agent that works by inhibiting the dissolution of hemostatic fibrin by plasmin, effectively preserving and stabilizing fibrin's matrix structure 1. While it has important clinical applications in managing bleeding, it can cause several side effects, including headache.

According to the FDA drug label, headache is specifically listed among the neurologic symptoms that can occur with tranexamic acid use or overdosage 1. The drug label states that neurologic symptoms of overdosage may include "visual impairment, convulsions, headache, mental status changes, and myoclonus" 1.

Clinical Applications and Headache Risk

Tranexamic acid is used in various clinical scenarios:

• Trauma management (within 3 hours of injury) 2
• Epistaxis (nosebleed) control 2
• Management of heavy menstrual bleeding
• Prophylaxis in patients with bleeding disorders 3

The risk of headache appears to be dose-dependent and may be more common with:

1. Higher doses of TXA
2. Oral administration (compared to topical application)
3. Prolonged use

Specific Evidence of Headache as Side Effect

In a study examining TXA for bleeding prevention in von Willebrand disease and Glanzmann thrombasthenia, headache was specifically reported as one of the adverse effects associated with TXA therapy 3. This provides direct evidence linking TXA to headache as a side effect.

Other Neurological Considerations

Beyond headache, TXA has been associated with other neurological effects:

• Dizziness: The FDA label specifically warns that "Tranexamic acid may cause dizziness" and advises patients to avoid driving or using machines until they know how the medication affects them 1
• Visual disturbances: A case report documented color vision disturbances in a pediatric patient after receiving oral TXA for epistaxis prophylaxis 4
• Seizures: TXA may cause seizures, including focal and generalized seizures, particularly at higher doses 1

Management of TXA-Associated Headache

If a patient develops headache while taking TXA:

1. Evaluate severity: Determine if the headache is mild and tolerable or severe and affecting quality of life
2. Consider dose adjustment: Lower doses may reduce headache occurrence while maintaining efficacy
3. Alternative antifibrinolytics: For patients with severe headaches, consider alternative agents like aminocaproic acid 4
4. Discontinuation: In cases of severe, persistent headache, discontinuation may be necessary, especially if other neurological symptoms develop

Risk-Benefit Assessment

When considering TXA use, clinicians should weigh the risk of headache against the potential benefits:

• For life-threatening bleeding (trauma, severe hemorrhage): Benefits clearly outweigh the risk of headache
• For non-urgent indications: Consider the patient's headache history and risk factors

Special Considerations

• Patients with migraine history: May be more susceptible to TXA-induced headaches
• Concomitant medications: Patients taking other medications that can cause headache may experience additive effects
• Duration of therapy: Short-term use (as in trauma) may have lower headache risk than long-term prophylactic use

In conclusion, headache is a recognized side effect of tranexamic acid that should be monitored and managed appropriately in patients receiving this medication. The risk appears to be dose-dependent and should be weighed against the clinical benefits of treatment.