JAK2 V617F Essential Thrombocythemia: Hydroxyurea causes headaches

Posted by ontheverge @ontheverge, May 29, 2023

On routine annual labwork in December of 2022, platelets were elevated (over 600 X1000/UL). At referral appointment with a hematologist in January 2023, platelets were 649 X1000/UL and my iron panel had low numbers. After six weeks of iron supplementation, platelets were 628 X1000/UL. Subsequent bone marrow biopsy detected "JAK2 V617F (c.1849G>T) mutation."

The first morning I took a hydroxyurea 500mg capsule I had the second migraine I've had in my 70+ year life. Since then I've been taking them with supper and wake up every morning with a sharp headache that usually resolves with a cup or two of coffee. I had another migraine when I took hydroxyurea on an empty stomach one night and had a migraine aura for several hours another morning with a less severe headache. If I forget or intentionally skip an evening dose, I wake headache free.

I rarely had headaches of any type before starting the hydroxyurea. After 15 days of once daily treatment, platelets were 572 X1000/UL. The plan is to continue once daily for two months, then reassess platelet level at the end of June. I'm not sure I can tolerate another month of headaches. My only risk factor is age >60. I am physically active and at a healthy weight with no other major health problems or medications. I have taken low dose aspirin once daily for years (NOT for cardiovascular risk factors) and continued that after the ET diagnosis.

I am tired of giving myself a daily headache which often wakes me early in the morning. I am considering stopping the hydroxyurea and am curious about other's experience. Of course, I will consult with my hematologist but they are away and not currently available.

Interested in more discussions like this? Go to the Blood Cancers & Disorders Support Group.

I just fell upon this reference stating that headaches can be one of the rare side effects of hydroxyurea:
https://www.mayoclinic.org/drugs-supplements/hydroxyurea-oral-route/side-effects/drg-20068109
I hope your hematologist can help you soon!

REPLY

Thanks. I read that it's a rare side effect. Being headache-free every time I forget a dose or while intentionally skipping it for as long as several days, confirms for me that the drug is the culprit. I was hoping the headaches would fade over time but that hasn't been the case so far.

REPLY

I know everyone is different and has different reactions to various meds/foods/ etc. My experience has been positive with Hydrea, although I know it has toxicity. My platelets were 1,250,000 when I was first diagnosed. The hematologist I had at the time ( in Venezuela) put me on 5 caps a day for a few days, then as my platelet count lowered, he lowered the dosage to4, 3, and now I have been on two a day for 8 years. I did experience heartburn almost immediately, for which he put me on an acid blocker, which I still take. i have had few side effects, but no headaches. My feet sometimes get blisters, and I've been to the dermatologist and asked my oncologist. It does seem to be like the hand foot problem some other cancer patients have with varied chemo. My brother in law also experienced problems with his feet being tender, sore skin peeling off, etc. But it has gotten better, I have learned that if you have a steroid injection for anything like arthritis, etc., or take steroids in a tablet for ling problems, which I also have, it elevates your platelets even more. The oncologist tells me that they give steroids to patients that have the opposite of what we have, which is Thrombocytopenia, low platelet count, i order to elevate their count so they won't have hemorraging problems.
Not sure if the headaches you are experiencing might go away in time, but wanted to write and tell you I have had a positive experience so far with Hydrea.
Now, my new doctor is wanting to change me to Anagrelide. I have heard from some that they have not had good experiences with it. It is also way more expensive. But the good part is that it only targets the platelets and not the white and red cells. So I am in the middle of a decision and unless I can find it cheaper and try it, I will stay on the Hydrea and keep and eye on the red and white cells. There is a lot to learn about all this and I am always looking for information about the disease/disorder or whatever they want to call it. But I am thankful they do have something to treat it with, or I probably would have had a stroke. I had a blood clot behind the knee when I was first diagnosed, very painful, and experienced a bad, sharp headache behind my left eye, which is what sent me to the doctors in the first place to find out what I had. I never have headaches, so that one was alarming. My blood pressure was high at the time, and I had always had low or good blood pressure.
I will add that I do have some swelling in the legs and feet that might be side effects, but also have other conditions that might explain this, and sores in the mouth on occasion. They will come every two or three weeks and I treat them with a mouthwash of equal parts of peroxide and water, and eventually they go away. The lack of energy I feel could be form this or several things combined. I will be 73 in a couple months and have been battling this since I was diagnosed at almost 65.
So, we continue on our journey, and I hope your headaches go away of they find another treatment that works better for you.
EsperanzaM

REPLY

Welcome @ontheverge

I am 79 and was diagnosed last year with ET JAK2 by labs and bone marrow biopsy. At diagnosis my platelets were 735. I started taking 500 mg daily HU (Hydroxyurea). I take a blood thinner for AFib so I do not take aspirin. Within two weeks I had daily headaches, feeling light headed and a first ever vertigo attack. I was taken HU for a month and then back on it every other day…very few headaches. I was thrilled when I had a platelet count of 434…my goal is to have platelets 450 or below.

I went through a very stressful period moving….many headaches and palpitations, Hematologist let me stop taking for a couple months, My platelets are 528 and I just started HU 500 mg but only on Monday/Wednesday/Friday…no headaches. Next lab is 6 weeks later. Hoping I can continue this.

I am now taking it with breakfast. You need to take with a full glass of water. I wet my lips and swirl water in my mouth, swallow the capsule, and follow up with rest of the water…helps prevent mouth sores. You need minimum 64 ounces of fluid daily to help rid the toxic effect of HU. I do not even touch the capsule. I tip it out to a different cap and tilt it into my mouth.

Good luck with your journey, Eileen

REPLY
@eileen11108

Welcome @ontheverge

I am 79 and was diagnosed last year with ET JAK2 by labs and bone marrow biopsy. At diagnosis my platelets were 735. I started taking 500 mg daily HU (Hydroxyurea). I take a blood thinner for AFib so I do not take aspirin. Within two weeks I had daily headaches, feeling light headed and a first ever vertigo attack. I was taken HU for a month and then back on it every other day…very few headaches. I was thrilled when I had a platelet count of 434…my goal is to have platelets 450 or below.

I went through a very stressful period moving….many headaches and palpitations, Hematologist let me stop taking for a couple months, My platelets are 528 and I just started HU 500 mg but only on Monday/Wednesday/Friday…no headaches. Next lab is 6 weeks later. Hoping I can continue this.

I am now taking it with breakfast. You need to take with a full glass of water. I wet my lips and swirl water in my mouth, swallow the capsule, and follow up with rest of the water…helps prevent mouth sores. You need minimum 64 ounces of fluid daily to help rid the toxic effect of HU. I do not even touch the capsule. I tip it out to a different cap and tilt it into my mouth.

Good luck with your journey, Eileen

Jump to this post

Thanks for sharing your history. It makes me hopeful that the headaches could eventually diminish. I figured out tipping the capsule into a the cap of the vial then tossing it into my mouth to comply with the do not touch medication recommendation. I usually drink it with a full glass of water but will be more mindful of that. I would love to take it with breakfast if I didn't have an all day headache after. Perhaps I can work up to that eventually. For now I will keep up the 500mg with supper until I see my hematologist in three weeks.

REPLY
@esperanzam

I know everyone is different and has different reactions to various meds/foods/ etc. My experience has been positive with Hydrea, although I know it has toxicity. My platelets were 1,250,000 when I was first diagnosed. The hematologist I had at the time ( in Venezuela) put me on 5 caps a day for a few days, then as my platelet count lowered, he lowered the dosage to4, 3, and now I have been on two a day for 8 years. I did experience heartburn almost immediately, for which he put me on an acid blocker, which I still take. i have had few side effects, but no headaches. My feet sometimes get blisters, and I've been to the dermatologist and asked my oncologist. It does seem to be like the hand foot problem some other cancer patients have with varied chemo. My brother in law also experienced problems with his feet being tender, sore skin peeling off, etc. But it has gotten better, I have learned that if you have a steroid injection for anything like arthritis, etc., or take steroids in a tablet for ling problems, which I also have, it elevates your platelets even more. The oncologist tells me that they give steroids to patients that have the opposite of what we have, which is Thrombocytopenia, low platelet count, i order to elevate their count so they won't have hemorraging problems.
Not sure if the headaches you are experiencing might go away in time, but wanted to write and tell you I have had a positive experience so far with Hydrea.
Now, my new doctor is wanting to change me to Anagrelide. I have heard from some that they have not had good experiences with it. It is also way more expensive. But the good part is that it only targets the platelets and not the white and red cells. So I am in the middle of a decision and unless I can find it cheaper and try it, I will stay on the Hydrea and keep and eye on the red and white cells. There is a lot to learn about all this and I am always looking for information about the disease/disorder or whatever they want to call it. But I am thankful they do have something to treat it with, or I probably would have had a stroke. I had a blood clot behind the knee when I was first diagnosed, very painful, and experienced a bad, sharp headache behind my left eye, which is what sent me to the doctors in the first place to find out what I had. I never have headaches, so that one was alarming. My blood pressure was high at the time, and I had always had low or good blood pressure.
I will add that I do have some swelling in the legs and feet that might be side effects, but also have other conditions that might explain this, and sores in the mouth on occasion. They will come every two or three weeks and I treat them with a mouthwash of equal parts of peroxide and water, and eventually they go away. The lack of energy I feel could be form this or several things combined. I will be 73 in a couple months and have been battling this since I was diagnosed at almost 65.
So, we continue on our journey, and I hope your headaches go away of they find another treatment that works better for you.
EsperanzaM

Jump to this post

My hematologist suggested Anagrelide in place of HU if headaches continue. I would not want to go that way as headaches are a common side effect and some have palpitations. I have AFib so afraid of palpitation side effect.

Look on Goodrx.com. I came up with a low price of $48 for 60 pills.

Eileen

REPLY

I do take hydroxyurea . I had. Headaches for a couple weeks they have now subsided. I take 1500 mgs

REPLY
@esperanzam

I know everyone is different and has different reactions to various meds/foods/ etc. My experience has been positive with Hydrea, although I know it has toxicity. My platelets were 1,250,000 when I was first diagnosed. The hematologist I had at the time ( in Venezuela) put me on 5 caps a day for a few days, then as my platelet count lowered, he lowered the dosage to4, 3, and now I have been on two a day for 8 years. I did experience heartburn almost immediately, for which he put me on an acid blocker, which I still take. i have had few side effects, but no headaches. My feet sometimes get blisters, and I've been to the dermatologist and asked my oncologist. It does seem to be like the hand foot problem some other cancer patients have with varied chemo. My brother in law also experienced problems with his feet being tender, sore skin peeling off, etc. But it has gotten better, I have learned that if you have a steroid injection for anything like arthritis, etc., or take steroids in a tablet for ling problems, which I also have, it elevates your platelets even more. The oncologist tells me that they give steroids to patients that have the opposite of what we have, which is Thrombocytopenia, low platelet count, i order to elevate their count so they won't have hemorraging problems.
Not sure if the headaches you are experiencing might go away in time, but wanted to write and tell you I have had a positive experience so far with Hydrea.
Now, my new doctor is wanting to change me to Anagrelide. I have heard from some that they have not had good experiences with it. It is also way more expensive. But the good part is that it only targets the platelets and not the white and red cells. So I am in the middle of a decision and unless I can find it cheaper and try it, I will stay on the Hydrea and keep and eye on the red and white cells. There is a lot to learn about all this and I am always looking for information about the disease/disorder or whatever they want to call it. But I am thankful they do have something to treat it with, or I probably would have had a stroke. I had a blood clot behind the knee when I was first diagnosed, very painful, and experienced a bad, sharp headache behind my left eye, which is what sent me to the doctors in the first place to find out what I had. I never have headaches, so that one was alarming. My blood pressure was high at the time, and I had always had low or good blood pressure.
I will add that I do have some swelling in the legs and feet that might be side effects, but also have other conditions that might explain this, and sores in the mouth on occasion. They will come every two or three weeks and I treat them with a mouthwash of equal parts of peroxide and water, and eventually they go away. The lack of energy I feel could be form this or several things combined. I will be 73 in a couple months and have been battling this since I was diagnosed at almost 65.
So, we continue on our journey, and I hope your headaches go away of they find another treatment that works better for you.
EsperanzaM

Jump to this post

just wondering, I am on HU (3 years now) but I also take an 81mg aspirin to keep platelets from sticking......are you also on aspirin? Why does your dr want to change you to Anagrelide if the HU is working....

REPLY
@1995victoria

just wondering, I am on HU (3 years now) but I also take an 81mg aspirin to keep platelets from sticking......are you also on aspirin? Why does your dr want to change you to Anagrelide if the HU is working....

Jump to this post

Well, yes, I do take an 81 mg baby aspirin every night. The reason he wants to change my medication is that he is concerned about the effect it is having on my red and white cells. Hydrea not only works to reduce the platelets which I have too many of, ( and they keep multiplying without the Hydrea (and they keep multiplying without treatment) but they also reduce the red and white cells, which I do not need reduced. It is a balance for sure that is hard to watch and keep. Because of this, as I understand it, there is a small chance that the Thrombocythemia can morph into another blood disorder. I won't get into it but you can look it up on this website about possible side effects of medications, etc,. Hydrea has worked well for me and I will ask him not to change it, but I understand that we have to watch for other effects on the white and red cells. Anemia, for one, but there are other possible complications that are rare. Other conditions that I have require occasional treatment with steroids which we who have this disease do not need. But with lung problems, and hip problems, as well as back problems, steroid injections are the only thing I can take for inflammation. I do not get or take them often, as I have learned the adverse effects. The Anagrelida he wants to put me on, is a lot more expensive and has a lot of possible unwanted side effects, which I already have problems with. (other conditions) However, it only reduces the platelets, not the red and white blood cells.

Hope this answered your questions.
I'm glad we can share here and be more informed for our future health.
Thanks for asking.
EsperanzaM in Texas.

REPLY
@eileen11108

My hematologist suggested Anagrelide in place of HU if headaches continue. I would not want to go that way as headaches are a common side effect and some have palpitations. I have AFib so afraid of palpitation side effect.

Look on Goodrx.com. I came up with a low price of $48 for 60 pills.

Eileen

Jump to this post

Eileen, thanks for this information. Will consider it for sure.
EsperanzaM in Texas

REPLY
Please sign in or register to post a reply.