Abstract Details

Title Use of Oral Aprepitant for the Management of Nausea with Inpatient Intravenous Dihydroergotamine (DHE) Use

Topic Headache

Presentation(s) S40 - (-)

Poster/Presentation
Number 006

Background Intravenous DHE is an effective acute treatment for migraine. Nausea is a common side effect of DHE and its control is associated with better headache outcome. Aprepitant is a selective antagonist of the neurokinin-1 receptor that mitigates the emetic effects of substance P. It is used in the prevention of postoperative and chemotherapy-induced nausea, but has not been previously studied in the prevention of DHE-related nausea.

Objective

Design/Methods We conducted a retrospective review of patients with migrainous disorders who were admitted to the UCSF Headache Center for a five-day course of intravenous DHE (cumulative dose 11.25mg) and received oral aprepitant as adjunctive anti-emetic therapy due to refractory nausea. Peak and average daily nausea scores were determined pre- and post- aprepitant from patients' hourly diaries. The efficacy of aprepitant was assessed via the following parameters: reduction in either average or peak daily nausea rating, cessation of emesis, and ?50% reduction in the number of PRN anti-nausea medications.

Results A total of fourteen cases were identified, with admission diagnoses of chronic migraine, medication overuse, and New Daily Persistent Headache of a migrainous type. In all patients, aprepitant was effective in reducing nausea in at least one of the three outcome measures. Four patients (29%) demonstrated a response in all parameters. In all patients who developed emesis (n=8), the addition of aprepitant resulted in cessation of emesis. No side effects from aprepitant were reported by any of the patients.

Conclusions Oral aprepitant appears to be a novel, effective, and well-tolerated treatment for controlling nausea and vomiting related to intravenous DHE. Confirmation of our findings through further prospective studies would improve current intravenous DHE protocols for the treatment of refractory headache.

Authors/Disclosures
Denise E. Chou, MD (Pfizer) PRESENTER	Dr. Chou has received personal compensation for serving as an employee of Pfizer. Dr. Chou has received personal compensation for serving as an employee of Amgen. Dr. Chou has stock in Pfizer. Dr. Chou has stock in Amgen.
Tomas Uher	Tomas Uher has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Tomas Uher has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol myers. Tomas Uher has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Tomas Uher has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Tomas Uher has received research support from Novartis.
Peter Goadsby, MD, PhD, FRS (University of California, Los Angeles)	Dr. Goadsby has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbvie. Dr. Goadsby has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli-Lilly. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aurene. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Pharmaceuticals. Dr. Goadsby has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma. Dr. Goadsby has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pfizer. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shiratronics. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CoolTech LLC. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PureTech Health LLC. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Vial. Dr. Goadsby has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aeon Biopharma. Dr. Goadsby has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Massachusetts Medical Society. The institution of Dr. Goadsby has received research support from NIHR. The institution of Dr. Goadsby has received research support from Kallyope. Dr. Goadsby has received publishing royalties from a publication relating to health care. Dr. Goadsby has received publishing royalties from a publication relating to health care. Dr. Goadsby has a non-compensated relationship as a Trustee with Migraine Trust that is relevant to AAN interests or activities. Dr. Goadsby has a non-compensated relationship as a Trustee with Organisation for Understanding Cluster Headache (UK) that is relevant to AAN interests or activities. Dr. Goadsby has a non-compensated relationship as a Executive roles with American Headache Society that is relevant to AAN interests or activities.

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