Post-infectious new daily persistent headache may respond to intravenous methylprednisolone

Abstract

New daily persistent headache (NDPH) is a subtype of chronic daily headache (CDH) that starts acutely and continues as a daily headache from the onset. It is considered as one of the most treatment refractory of all headache syndromes. The pathophysiology is largely unknown. Viral infections, extracranial surgery, and stressful life events are considered as triggers for the onset of NDPH. A few patients may have the onset of their symptoms during an infection. Here we report nine patients with NDPH like headache. All of them had a history suggestive of extracranial infections a few weeks prior to the onset of headache. All patients received intravenous methyl prednisolone (IV MPS) for 5 days. Intravenous MPS was followed by Oral steroids for 2–3 weeks in six patients. The relief of headache started between the second and fifth days of infusion in all patients. The steady improvement in headache continued and seven patients experienced almost complete improvement within 2 weeks. Two other patients showed complete improvement between 6 and 8 weeks after initiation of IV MPS therapy. We conclude that NDPH-like headache may occur as a post infectious process following a recent infection. We also speculate on the possible mechanisms of headache in our patients.

New Daily–Persistent Headache Versus Tension-type Headache

“…Unlike pure TTH, where triptans have no therapeutic gain [34], triptans seem to give at least some pain relief in up to one third of patients with NDPH, even if they lack migraine features [6••]. Intravenous methylprednisolone recently has been reported to cause partial or complete remission in a small series of patients with NDPH who reported an infectious trigger [35]. Intravenous haloperidol [36] and intravenous magnesium [23] also have been reported to demonstrate some efficacy.…”

The Heterogeneity of New Daily Persistent Headache

“…Of these 16 patients, 9 had CSF sampling within 3 months, and 7 had CSF sampling within 6 weeks of headache onset, all of which were within normal limits. In a small series of 9 patients with “postinfectious NDPH,” abnormalities were found in 2 of the 6 patients who underwent CSF analysis . However, both of these patients had a headache duration of less than 3 months.…”

New Daily Persistent Headache: Clinical Perspective

“…IV Corticosteroids Recently, Prakash and Shah 30 reported on 9 patients with post‐infectious NDPH. All patients were given high‐dose intravenous methylprednisolone for 5 days.…”