From the Guidelines
For patients on a heparin drip experiencing severe headaches, acetaminophen (650-1000mg every 4-6 hours as needed) is a safe and recommended medication option.
Key Considerations
- Avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, as they may further increase the risk of bleeding in patients on heparin therapy 1.
- Although acetaminophen alone is noted to be ineffective for migraines in some guidelines 1, in the context of heparin therapy, it is still considered a safer alternative for managing severe headaches due to its lack of effect on platelet function.
Alternative Options
- Ketorolac (15-30mg every 6 hours as needed, not to exceed 5 days) may be considered, but its use should be limited due to the potential increased risk of bleeding, similar to other NSAIDs. It is crucial to weigh the benefits and risks of each medication option and consider the patient's individual circumstances and medical history when selecting a treatment for severe headaches in patients on heparin therapy.
From the FDA Drug Label
7.2 Platelet Inhibitors Drugs such as NSAIDS (including salicylic acid, ibuprofen, indomethacin, and celecoxib), dextran, phenylbutazone, thienopyridines, dipyridamole, hydroxychloroquine, glycoprotein IIb/IIIa antagonists (including abciximab, eptifibatide, and tirofiban), and others that interfere with platelet-aggregation reactions (the main hemostatic defense of heparinized patients) may induce bleeding and should be used with caution in patients receiving heparin sodium.
Medications to avoid for severe headache in a patient on a heparin infusion include:
- NSAIDs (e.g. ibuprofen, indomethacin, celecoxib) due to increased risk of bleeding 2 No conclusion can be drawn regarding safe alternatives. 2
From the Research
Medication Options for Severe Headache
- Acetaminophen (1,000 mg) and aspirin (650 mg) are clinically similar in treating headaches, but their use should be based on individual patient suitability and cost factors 3
- However, for a patient on a heparin (unfractionated heparin) infusion, aspirin may not be a suitable option due to its antiplatelet effects, which could increase the risk of bleeding when combined with heparin
Alternative Treatment Approaches
- Manual therapy, including physical therapy techniques, has been shown to be effective in treating tension-type headache, improving symptoms, and increasing patients' well-being 4
- This approach may be considered as an alternative or complementary treatment for severe headache in patients on heparin infusion, but its effectiveness in this specific population is not directly addressed in the available studies
Considerations for Patients on Heparin Infusion
- There is limited evidence directly addressing the safety of medications for severe headache in patients on heparin infusion
- Acetaminophen may be a safer option than aspirin or other antiplatelet medications, but its effectiveness and safety should be carefully evaluated in the context of the patient's individual condition and treatment plan 3