Paroxysmal migraine associated with vancomycin administration: A case report, a review of pharmacovigilance databases for similar cases and possible mechanisms

Vancomycin is a core drug for the treatment of methicillin-resistant Staphylococcus aureus, but its neurologic adverse effects are rarely reported. This case is the first to report a possible association between intravenous vancomycin and episodic migraine. Rapid identification of drug-induced migraine can avoid unnecessary invasive testing and medication delays and has direct clinical value.

To report and document a case of episodic migraine that was highly correlated with the timing of intravenous vancomycin administration, assessing causality and its general clinical significance.

This narrative case report is accompanied by an assessment of drug causality and supplemented by a review of pharmacovigilance databases. A systematic search using keywords was conducted. Inclusion criteria included case, cohort, or pharmacovigilance data related to headache/migraine use with glycopeptide drugs. Primary headaches unrelated to the drug were excluded.

A 54-year-old woman was admitted to the hospital with traumatic injuries resulting in bilateral lower extremity pain and a 1-hour bleeding episode on the left leg. The injuries included multiple fractures and traumatic injuries, and a postoperative wound infection developed.

Based on wound culture results, the patient was treated with intravenous vancomycin. During intravenous vancomycin treatment, the patient developed episodic migraines, and a causal relationship to vancomycin was confirmed using the Naranjo score. After discontinuation of vancomycin, the patient's episodic migraines gradually resolved. The patient's episodic migraines resolved completely within 3 days, and the same symptoms did not recur during subsequent treatment. The patient remained headache-free for 3 months after discharge.

Pharmacovigilance data indicate that headaches associated with intravenous administration are rare but do occur with glycopeptide drugs. This review suggests that vancomycin may induce episodic migraines, a rare adverse effect that should be included in the differential diagnosis of acute headaches associated with intravenous glycopeptide drugs. Pharmacovigilance combined with therapeutic drug monitoring may serve as a low-cost, reproducible clinical identification tool. This case suggests a possible association between vancomycin and episodic migraines but does not directly prove causation, and further research is needed.