Headache due to Ventolin® (salbutamol)?

Question

Hello,
our 7-year-old daughter suffers for about 3 months regularly about 3 hours after the inhalation in the mornings of 3-4 puffs Ventolin® (salbutamol aerosol) and 6% NaCl from partly very strong haedache. An EEG and further investigations have been without pathological findings. Could this headache be due to a ceased effect of Ventolin®? (Withdrawl symptoms?)
If not, can this have another CF-related cause?
We are looking forward to your answer and thank you very much,
J.S.

Answer

Hello,
you report, that your daughter, who inhales for 3 months in the mornings with 3-4 puffs (!!) Ventolin® and additionally with 6% NaCl, suffers nearly regularly, from partly very strong headache. You ask about a possible reason for this headache.
All together, headache is not a rare phenomenon in CF patients.
Headache, that is located mainly in the front area, can be caused by an inflammatory process in the frontal sinus. In the mornings after sleeping and getting up, patients with advanced lung problems complain not rarely about headache, if the concentration of carbon dioxide is increased. Tesions of the neck and nuchal muscles can also be the reason for recurrent headache.
In the case of your daughter, however, I assume in the first place a reaction to the inhalation of Ventolin®. The dosage of 3-4 puffs as a single dose seems to me quite high for a 7-year-old child. Headache is a quite known side-effect in case of Ventolin® inhalation, especially if it is a long lasting therapy with high dosage.
You should therefore make in consultation with your CF physicians a trial to reduce markedly the dosage of Ventolin® or if possible, to quit it for a few days and observe under these conditions if the headache stays or disappears.
I hope that the headache will disappear quickly.

Yours sincerely,
Dr. H.-G. Posselt

28.07.2014