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What Causes Headaches After Taking Doryx?
Question: My daughter (21 years old) has been taking Doryx (doxycycline hyclate) for acne for approximately 60 days, without side effects. She had a headache yesterday, which went away with Advil. We assumed it was from her period. The headache is back today. Should we suspect any connection to the Doryx?
Brief Answer:
Stop Doxycycline
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Doxycycline has been implicated in the causation of benign intracranial hypertension (BIH). Headache being the most common symptom of BIH.
BIH should be considered when anyone taking doxycycline begins to complain of a new headache.
A fundoscopic evaluation to look for papilledema( a sign of raised intracranial pressure) and testing for visual acuity and visual fields is justified.
The logical step here would be to discontinue doxycycline temporarily and if the headache subsides on discontinuation, doxycycline is probably the cause.
Regards
Stop Doxycycline
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Doxycycline has been implicated in the causation of benign intracranial hypertension (BIH). Headache being the most common symptom of BIH.
BIH should be considered when anyone taking doxycycline begins to complain of a new headache.
A fundoscopic evaluation to look for papilledema( a sign of raised intracranial pressure) and testing for visual acuity and visual fields is justified.
The logical step here would be to discontinue doxycycline temporarily and if the headache subsides on discontinuation, doxycycline is probably the cause.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Where do we go to get a "fundoscopic evaluation to look for...."? Is this something I should have our dermatologist arrange??
I will admit you have frightened me very, very much.
I will admit you have frightened me very, very much.
Brief Answer:
Stop Doxycycline
Detailed Answer:
Hi.
I am extremely sorry if I frightened you, but my purpose was to make you aware of this possibility. I am not saying that she certainly has BIH, pending investigation. Her headache might very well be unrelated.
Anyways, I must assure you that BIH subsides on discontinuing the implicated drug and that is all that is required in those who develop BIH.
Doxycycline is such a common drug prescribed for acne. However, doxycycline may cause BIH, so as a precaution she needs to discontinue it immediately as in anyone taking doxycycline who begins to complain of a new headache.
Fundoscopy to look for papilledema can be performed by an ophthalmologist or a neurologist along with visual acuity and field testing. Your dermatologist would refer her to an ophthalmologist, if deemed appropriate e.g if the headache persists.
Regards
Stop Doxycycline
Detailed Answer:
Hi.
I am extremely sorry if I frightened you, but my purpose was to make you aware of this possibility. I am not saying that she certainly has BIH, pending investigation. Her headache might very well be unrelated.
Anyways, I must assure you that BIH subsides on discontinuing the implicated drug and that is all that is required in those who develop BIH.
Doxycycline is such a common drug prescribed for acne. However, doxycycline may cause BIH, so as a precaution she needs to discontinue it immediately as in anyone taking doxycycline who begins to complain of a new headache.
Fundoscopy to look for papilledema can be performed by an ophthalmologist or a neurologist along with visual acuity and field testing. Your dermatologist would refer her to an ophthalmologist, if deemed appropriate e.g if the headache persists.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks...your reply didn't come up until I asked anothe question, so please disregard my "No reply?"
I appreciate the clarification. I called our dermatologist who called back immediately. (I originally sought advice here since, frankly, our dermatologist is not often terribly responsive.) He advised us to stop the doxy until she has no headache for 3 days, and if the headache does NOT subside by tomorrow, to see our Primary Care Physician.
I am very discouraged, as is my daughter, as we worry that 3 days off the doxy will create another breakout. Perhaps if that happens, it's an indication the doxy wasn't going to be a long-term answer anyway. May I ask your opinion on this?
It seems the doxy helped quite a bit, EXCEPT for the week before her period, when she broke out again (both times within the 60 days she's been on the doxy). So our derm is saying oral contraceptives should be tried next. What do you think?
Again, we are terribly discouraged.
I appreciate the clarification. I called our dermatologist who called back immediately. (I originally sought advice here since, frankly, our dermatologist is not often terribly responsive.) He advised us to stop the doxy until she has no headache for 3 days, and if the headache does NOT subside by tomorrow, to see our Primary Care Physician.
I am very discouraged, as is my daughter, as we worry that 3 days off the doxy will create another breakout. Perhaps if that happens, it's an indication the doxy wasn't going to be a long-term answer anyway. May I ask your opinion on this?
It seems the doxy helped quite a bit, EXCEPT for the week before her period, when she broke out again (both times within the 60 days she's been on the doxy). So our derm is saying oral contraceptives should be tried next. What do you think?
Again, we are terribly discouraged.
Brief Answer:
Acne vulgaris
Detailed Answer:
Hi.
I apologise for some delay in my reply.
If I was the treating doctor I would have started her on Oral Azithromycin if the severity of acne warrants her to be on oral treatment.
Azithromycin unlike doxycycline is given in a pulse dose e.g 500 mg on three consecutive day/week for 4-6 weeks. Azithromycin has many advantages as compared to doxycycline: Tt is as effective as doxycycline, in fact better in my experience. Azithromycin is also devoid of the side effect like BIH and also it can be given in combination with Oral retinoids (Accutane) unlike doxycycline which carries even greater chances of causing BIH, if combined with retinoids.
Apart from oral antibiotic, topical's like clindamycin 1% gel or benzoyl peroxide 2.5% gel can be used, once or twice daily.
Oral contraceptives are definitely an option in females, specially in those who have acne flares around the times of menses, even otherwise.
I would suggest a few blood test for her to document any underlying hormonal abnormality, before she is started on oral contraceptives e.g serum testosterone, serum DHEAS, serum Prolactin, Serum Luteinizing hormone, Serum Follicle stimulating hormone etc.
Regards
Acne vulgaris
Detailed Answer:
Hi.
I apologise for some delay in my reply.
If I was the treating doctor I would have started her on Oral Azithromycin if the severity of acne warrants her to be on oral treatment.
Azithromycin unlike doxycycline is given in a pulse dose e.g 500 mg on three consecutive day/week for 4-6 weeks. Azithromycin has many advantages as compared to doxycycline: Tt is as effective as doxycycline, in fact better in my experience. Azithromycin is also devoid of the side effect like BIH and also it can be given in combination with Oral retinoids (Accutane) unlike doxycycline which carries even greater chances of causing BIH, if combined with retinoids.
Apart from oral antibiotic, topical's like clindamycin 1% gel or benzoyl peroxide 2.5% gel can be used, once or twice daily.
Oral contraceptives are definitely an option in females, specially in those who have acne flares around the times of menses, even otherwise.
I would suggest a few blood test for her to document any underlying hormonal abnormality, before she is started on oral contraceptives e.g serum testosterone, serum DHEAS, serum Prolactin, Serum Luteinizing hormone, Serum Follicle stimulating hormone etc.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
No need to apologize for any delay! I am learning so much from you and, in a very dark time, you are a beacon of light.
Where are you located? Is there any possibility my daughter can be treated by you? We live in NJ and can travel anywhere in the tri-state area..further if necessary.
We've been to 2 dermatologists and never, ever heard about azithromycin! We were told of a regimen that would progress to Accutance, if we chose, only after Doxy failed after 90 days. We are very, very hesitant to go to Accutane - if we go that route, we'd need to feel much greater confidence in her physician. Also, we were given NO advice about testing for hormone levels.
My daughter has felt all along that her dermatologists have not given her case enough time or thought - that she's been given a "knee-jerk" reaction type of treatment. I have fought against that feeling, but I can see that, compared to even an email exchange with you, her feeling is more correct than not.
Please let me know where you are located and if you can treat my daughter.
Where are you located? Is there any possibility my daughter can be treated by you? We live in NJ and can travel anywhere in the tri-state area..further if necessary.
We've been to 2 dermatologists and never, ever heard about azithromycin! We were told of a regimen that would progress to Accutance, if we chose, only after Doxy failed after 90 days. We are very, very hesitant to go to Accutane - if we go that route, we'd need to feel much greater confidence in her physician. Also, we were given NO advice about testing for hormone levels.
My daughter has felt all along that her dermatologists have not given her case enough time or thought - that she's been given a "knee-jerk" reaction type of treatment. I have fought against that feeling, but I can see that, compared to even an email exchange with you, her feeling is more correct than not.
Please let me know where you are located and if you can treat my daughter.
Brief Answer:
Acne
Detailed Answer:
Hi again.
Hi. I can understand her concern and frustration. A lot of people who have acne go through this feeling. As a parent your desire to get her rid of her acne is absolutely genuine. However, she must understand that treatment of acne is often long and there is no one time solution to it. Patience is the key.
Moreover, since acne is a recurrent condition up to a certain age, which may vary from individual to individual, therefore once her acne is brought under control she should still continue with the topical retinoid (Adapalene gel) as a maintenance treatment. Retinoids are comedolytic as well as antiinflammatory and hence would prevent formation of new acne.
Regarding the choice between azithromycin or doxycycline, I am sure your dermatologist would definitely consider Azithromycin if he feels the need for an oral antibiotic. The choice of an antibiotic is largely a personal one and guided by the experience of the doctor with that particular antibiotic. I may prefer azithromycin, he may prefer doxycycline!
Accutane is reserved for severe Or unresponsive acne and is definitely worth a consideration if she is not responding to conventional treatment and there is no history suggestive of hormonal irregularity in her.
I am sure your dermatologist must have ruled out underlying hormonal abnormality in her from history. He must have asked about any irregularity in menstrual cycle Or coarse facial hair?
As I mentioned before, OCP’s are an option in females even if the hormonal tests are normal, especially in those who have acne flares around menses. Therefore, ruling out hormonal abnormality based on history is sometimes sufficient without resorting to hormonal testing.
I am situated too far, on an altogether different continent (I reside in India) but I would be glad to help you online.
I would suggest you to stick to the treatment, follow up regularly with your dermatologist and be patient. A doctor usually modifies the treatment depending on the response, therefore the need for follow up.
Regards
Acne
Detailed Answer:
Hi again.
Hi. I can understand her concern and frustration. A lot of people who have acne go through this feeling. As a parent your desire to get her rid of her acne is absolutely genuine. However, she must understand that treatment of acne is often long and there is no one time solution to it. Patience is the key.
Moreover, since acne is a recurrent condition up to a certain age, which may vary from individual to individual, therefore once her acne is brought under control she should still continue with the topical retinoid (Adapalene gel) as a maintenance treatment. Retinoids are comedolytic as well as antiinflammatory and hence would prevent formation of new acne.
Regarding the choice between azithromycin or doxycycline, I am sure your dermatologist would definitely consider Azithromycin if he feels the need for an oral antibiotic. The choice of an antibiotic is largely a personal one and guided by the experience of the doctor with that particular antibiotic. I may prefer azithromycin, he may prefer doxycycline!
Accutane is reserved for severe Or unresponsive acne and is definitely worth a consideration if she is not responding to conventional treatment and there is no history suggestive of hormonal irregularity in her.
I am sure your dermatologist must have ruled out underlying hormonal abnormality in her from history. He must have asked about any irregularity in menstrual cycle Or coarse facial hair?
As I mentioned before, OCP’s are an option in females even if the hormonal tests are normal, especially in those who have acne flares around menses. Therefore, ruling out hormonal abnormality based on history is sometimes sufficient without resorting to hormonal testing.
I am situated too far, on an altogether different continent (I reside in India) but I would be glad to help you online.
I would suggest you to stick to the treatment, follow up regularly with your dermatologist and be patient. A doctor usually modifies the treatment depending on the response, therefore the need for follow up.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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