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

Background: 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. Objective: 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. Methods: 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. Case: 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. Results: 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. Conclusion: 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.