Many patients complain of headache and fatigue when taking methotrexate so you are not unique. We recommend that all patients on MTX receive folic acid at a dose of at least 5 mg/week (we ususally use 1 mg/day). Folic acid is often very helpful in managing these complaints. Sometimes we use an even stronger form of folic acid called leukovorin given 12 and sometimes 24 hours after methotrexate that also seems to help with headache, fatigue, nausea, and hairloss which sometimes occur with methotrexate.
About Clifton Bingham, III, MD
Associate Professor of Medicine
Director - Johns Hopkins Arthritis Center