SYNOPSIS The persistence and reactivation of classic viruses may be responsible for some chronic headache syndromes and their exacerbations. Persistent infections may selectively decrease neurotransmitter output. Alternatively, headache may be due to the viral‐induced immune response. Lymphocytes secrete substances with CNS activity. Continuous antigenic stimulation may result in immune complexes, anti‐idiotype antibodies, and autoimmunity. Our studies show an increased incidence of raised thyroid microsomal antibodies in patients with chronic benign daily headache or benign paroxysmal vertigo (a syndrome closely related to idiopathic headache syndrome). We detected oropharyngeal secretion of Epstein‐Barr Virus by nucleic acid hybridization in 20 of 32 patients with the recently‐defined syndrome of new, daily persistent headache and in only 4 of 32 age and sex‐matched control patients. Based on these studies, we propose that chronic benign daily headache may be an auto‐immune disorder with a persistent viral trigger.

New daily persistent headache (NDPH) is an idiopathic headache syndrome characterized by the abrupt onset of an unremitting, daily, continuous headache without an antecedent escalating headache pattern, and not attributable to other primary or secondary headache disorders. We review the history of NDPH in terms of its characterization and classification, and then interview Dr. Walter Vanast, the neurologist who initially described NDPH three decades ago, to gain his perspective now that there is more widespread recognition and interest in this syndrome.

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By focusing on a single therapy—surgical treatment of headache—this article defines the broad pattern of early white reactions to native healing in the North American Arctic. Many Europeans, particularly those with medical training, denied the value of indigenous surgery. Missionaries, to the contrary, recognized its success, and thought its suppression necessary: "cutting" reinforced native religious concepts by providing an exit for illness-causing spirits. When they could not deny the efficacy of traditional therapy, Europeans resorted to naturalistic explanations. In practice, they realized, there was little difference between indigenous arctic and European surface surgery: both produced bleeding and counterirritation. Native healers, it followed, were unwittingly applying contemporary European treatments; alternatively, they had learned effective procedures through contact with whites. Only very rarely did newcomers incorporate indigenous therapeutic concepts into their treatment of native patients. With few exceptions, Europeans failed to recognize inherent value in traditional northern healing.