Can vonoprazan (proton pump inhibitor) cause headache in an otherwise normal person?

Vonoprazan and Headache: Association and Management

Vonoprazan can cause headache as an adverse effect in otherwise normal individuals, though it is not among the most commonly reported side effects of this potassium-competitive acid blocker.

Understanding Vonoprazan

• Vonoprazan (Voquezna®) is a first-in-class potassium-competitive acid blocker (PCAB) approved for treating erosive esophagitis and non-erosive gastroesophageal reflux disease (GERD) 1
• It inhibits H+,K+-ATPase activities in a reversible and potassium-competitive manner with approximately 350 times higher potency than proton pump inhibitors like lansoprazole 2
• Vonoprazan provides stronger and more sustained gastric acid control compared to traditional PPIs with once-daily dosing 1, 3

Adverse Effects Profile

• The most commonly reported adverse events with vonoprazan include:

  • Abdominal pain 1, 4
  • Constipation 2, 1
  • Diarrhea 2, 1
  • Nausea 1, 4
  • Dyspepsia 1

• In clinical trials, headache was not among the most frequently reported adverse effects:

  • Nasopharyngitis was the only adverse event reported by at least 5.0% of patients (6.94% vonoprazan vs. 5.07% PPI) 4
  • Mild to moderate adverse drug reactions occurred at frequencies of 8-17% in pre-approval studies 2

Headache Considerations

• While headache is not specifically listed among the most common adverse effects in vonoprazan studies, it's important to note that:
  • Headache is a common adverse effect with many medications, including those affecting the gastrointestinal system
  • If a patient develops headache while taking vonoprazan, it should be evaluated in the context of:
    • Timing relative to medication initiation
    • Pattern and characteristics of the headache
    • Other potential causes

Clinical Approach to Medication-Related Headache

• When evaluating headache potentially related to vonoprazan:

  • Document headache characteristics (location, quality, severity, aggravating factors) 5
  • Assess for accompanying symptoms such as photophobia, phonophobia, nausea, or vomiting 5
  • Consider if the headache meets criteria for primary headache disorders like migraine 5

• Management options for medication-related headache include:

  • Simple analgesics like acetaminophen, aspirin, ibuprofen, or naproxen for mild to moderate headache 5
  • If headaches persist or are severe, consider:
    • Medication adjustment (timing, dose)
    • Alternative acid-suppressing medication
    • Consultation with a specialist if headaches are severe or persistent

Important Clinical Considerations

• Distinguish between medication-related headache and primary headache disorders:

  • Medication-related headaches typically have temporal relationship to drug administration
  • Primary headache disorders like migraine have specific diagnostic criteria 5

• If headaches are severe, persistent, or associated with other neurological symptoms, further evaluation may be warranted to rule out secondary causes 5

• For patients with pre-existing headache disorders, monitor for potential exacerbation after starting vonoprazan 5