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Sadeghpour M, Abdolizadeh A, Yousefi P, Rastegar-Kashkouli A, Chitsaz A. New Daily Persistent Headache (NDPH): Unraveling the Complexities of Diagnosis, Pathophysiology, and Treatment. Curr Pain Headache Rep 2023; 27:551-559. [PMID: 37632682 DOI: 10.1007/s11916-023-01161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE OF REVIEW The current article aims to provide an overview of new daily persistent headache (NDPH), with a particular emphasis on its pathophysiology, evaluation, and current treatment options. RECENT FINDINGS NDPH is an uncommon and heterogeneous condition associated with various comorbidities and is of great significance due to its prolonged duration and high severity. Variable causes and clinical aspects of NDPH may reflect differences in its underlying pathophysiological mechanisms, including genetics, environmental triggers, neuroinflammation, and brain changes. When assessing a patient with NDPH, potential triggers, past medical history, and differential diagnosis should be carefully considered. Non-pharmacological interventions aimed to improve diet, sleep patterns, and reduce consumption of caffeine and alcohol are recommended for all patients. Nerve blockade and nerve stimulation seem to be more efficacious in children than adults. Antiviral medications and neuroinflammation-targeting treatments may be helpful, particularly, when an infectious disease or severe inflammation is suspected. NDPH patients with concurrent affective disorders may benefit from treatment with serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or benzodiazepines. Cerebrospinal-fluid-lowering medications may be useful for headaches started with a thunderclap or a Valsalva maneuver. Possible treatments for refractory NDPH include intravenous ketamine or lidocaine, onabotulinumtoxinA, and calcitonin gene-related peptide antibodies. Considering the variety of NDPH, it is critical to properly screen patients for correct diagnosis. Proper identification of potential mimics may enable precise therapy opportunities, yet there is no gold standard treatment for NDPH. Further well-designed studies are needed to elucidate the underlying mechanisms and develop effective treatment strategies for NDPH.
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Affiliation(s)
- Majid Sadeghpour
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Abdolizadeh
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pourya Yousefi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmad Chitsaz
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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The Enigma of New Daily Persistent Headache: What Solutions for Pediatric Age? Curr Pain Headache Rep 2022; 26:165-172. [DOI: 10.1007/s11916-022-01011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
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Papetti L, Sforza G, Tarantino S, Moavero R, Ruscitto C, Ursitti F, Ferilli MAN, Vigevano F, Valeriani M. Features and Management of New Daily Persistent Headache in Developmental-Age Patients. Diagnostics (Basel) 2021; 11:diagnostics11030385. [PMID: 33668316 PMCID: PMC7996357 DOI: 10.3390/diagnostics11030385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction. Our aim was to investigate the clinical features of primary new daily persistent headache (NDPH) in a cohort of paediatric patients. Methods. We reviewed the data of patients with persistent daily headache, attending the Headache Centre of Bambino Gesù Children from the January 2009. The ICHD-III criteria were used for diagnosis. Statistical analysis was conducted to study possible correlations between NDPH and population features (age and sex), NDPH and headache qualitative features, and NDPH and response to pharmacological therapies. Results. We included 46 subjects with NDPH. The features of pain more closely resembled those of migraine than to those of tension-type headache (62 vs. 38%). The NDPH patients showed nausea and vomiting less frequently than migraine ones (28.6 vs. 48.2%, p < 0.01). A total of 75% of NDPH patients experienced an onset of the symptoms in the winter months (November to February) (p < 0.01). NDPH was less common in very young children under 10 years of age. Almost 58% of NDPH patients received pharmacological therapy and the most used drug was amitriptyline. A reduction of attacks by at least 50% in a month was detected in 30.6% of patients. Conclusions. NDPH can be very disabling and correlates with seasonal factors. Although long term pharmacological therapy is recommended, considering the long duration that this headache can have, there are no data supporting the treatment choice.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Giorgia Sforza
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Samuela Tarantino
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Romina Moavero
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Fabiana Ursitti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Federico Vigevano
- Department of Neuroscience, Neurology Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Massimiliano Valeriani
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
- Correspondence: ; Tel.: +39-066-859-2289
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Reidy BL, Riddle EJ, Powers SW, Slater SK, Kacperski J, Kabbouche MA, Hershey AD. Clinic-based characterization of continuous headache in children and adolescents: Comparing youth with chronic migraine to those with new daily persistent headache. Cephalalgia 2020; 40:1063-1069. [PMID: 32336121 DOI: 10.1177/0333102420920644] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the headache characteristics and functional disability of a large sample of treatment-seeking youth with continuous headache and compare these factors across diagnostic subgroups of chronic migraine and new daily persistent headache. METHODS This retrospective study utilized clinical information (e.g. diagnosis, headache features, medication overuse, functional disability) from a large data repository of patients initially presenting to a multidisciplinary headache center with continuous headache. Patient inclusion in subgroup analyses for chronic migraine and new daily persistent headache was based on clinician diagnosis using International Classification of Headache Disorders (ICHD) criteria. RESULTS The current sample included 1170 youth (mean age = 13.95 years, 78.8% female) with continuous headache. The overwhelming majority of these youth had headaches with migrainous features, regardless of their clinical diagnosis. Youth with chronic migraine reported a longer history of continuous headache symptoms and earlier age of headache onset than youth with new daily persistent headache and were more likely to have medication overuse. Most youth with continuous headache experienced severe migraine-related functional disability, regardless of diagnostic subgroup. CONCLUSIONS Overall, youth with continuous chronic migraine and new daily persistent headache did not have clinically meaningful differences in headache features and associated disability. Findings suggest that chronic migraine and new daily persistent headache may be variants of the same underlying disease.
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Affiliation(s)
- Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily J Riddle
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew D Hershey
- Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Stubberud A, Cheema S, Tronvik E, Matharu M. Nutcracker syndrome mimicking new daily persistent headache: A case report. Cephalalgia 2020; 40:1008-1011. [PMID: 32295399 PMCID: PMC7691626 DOI: 10.1177/0333102420918554] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Compression of the duodenum and left renal vein between the aorta and superior mesenteric artery usually leads to symptoms of proximal bowel obstruction or hematuria and, more rarely, nonspecific mild headaches. CASE A young woman presented with new daily persistent headache refractory to numerous pharmacological treatments, onabotulinumtoxinA, nerve blocks, and occipital nerve stimulation. Following several years of daily severe headache, worsening abdominal pain and intolerance for food intake led to the discovery of aortomesenteric compression. Surgical treatment gave prompt improvement in gastric symptoms but also essentially resolved the headache. CONCLUSION This is the first description of new daily persistent headache in association with aortomesenteric compression as well as marked improvement of headache following aortomesenteric decompression. In patients with new daily persistent headache and orthostatic symptoms one may consider a differential diagnosis of Nutcracker syndrome, especially in patients with comorbid hypermobility syndromes, hematuria or gastric symptoms.
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Affiliation(s)
- Anker Stubberud
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Özge A, Faedda N, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, Sergeev A, Barlow K, Uludüz D, Yalın OÖ, Lipton RB, Rapoport A, Guidetti V. Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. J Headache Pain 2017; 18:109. [PMID: 29285570 PMCID: PMC5745373 DOI: 10.1186/s10194-017-0818-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. METHODS Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. RESULTS Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. CONCLUSIONS Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Noemi Faedda
- Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Amy A. Gelfand
- UCSF Headache Center and UCSF Benioff Children’s Hospital, Pediatric Brain Center 2330 Post St 6th Floor San Francisco, Campus Box 1675, San Francisco, CA 94115 USA
| | - Peter James Goadsby
- NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College London, London, England
| | - Jean Christophe Cuvellier
- Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children’s Hospital, Lille, France
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark
| | - Alexey Sergeev
- Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia
| | - Karen Barlow
- Faculty of Medicine, University of Calgary, Alberta Children’s Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8 Canada
| | - Derya Uludüz
- Cerrahpaşa Medical Faculty, Department of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey
| | - Osman Özgür Yalın
- İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey
| | - Richard B. Lipton
- Department of Neurology Montefiore Headache Center, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY 10461 USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
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Young WB. New daily persistent headache: controversy in the diagnostic criteria. Curr Pain Headache Rep 2011; 15:47-50. [PMID: 21116742 DOI: 10.1007/s11916-010-0160-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
New daily-persistent headache is a relatively uncommon type of chronic daily headache. The critical features of the original description and the subsequent Silberstein-Lipton description was the onset: daily headache starts abruptly without a background of frequent or worsening headache. In 2004, the International Headache Society classification committee excluded an abundance of migrainous features. The exclusion of patients with too many migrainous features from the International Headache Society classification was contentious from the onset and is a source of consternation for many headache experts. Many contend that the sudden onset of a daily headache raises the same issue of what turned on the headache, irrespective of the headache features. Switch-related questions about predisposing factors or precipitating events are equally valid regardless of how many migrainous features the patient has. The differential diagnosis, treatment response, or prognoses do not vary by the number of migrainous features. The current International Headache Society definition excludes more than half of patients with new onset of daily headache. This exclusion due to migrainous features could have adverse scientific, diagnostic, and treatment consequences.
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Affiliation(s)
- William B Young
- Thomas Jefferson University, Jefferson Headache Center, 111 South 11th Street, Philadelphia, PA 19107, USA.
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Kaniecki RG, Taylor FR, Landy SH. Abstracts and Citations. Headache 2010. [DOI: 10.1111/j.1526-4610.2010.01750.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Ann Pakalnis
- Division of Pediatric Neurology, Ohio State University, USA
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Robbins MS, Grosberg BM, Napchan U, Crystal SC, Lipton RB. Clinical and prognostic subforms of new daily-persistent headache. Neurology 2010; 74:1358-64. [PMID: 20421580 DOI: 10.1212/wnl.0b013e3181dad5de] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND According to the International Classification of Headache Disorders (ICHD)-2, primary daily headaches unremitting from onset are classified as new daily-persistent headache (NDPH) only if migraine features are absent. When migraine features are present, classification is problematic. METHODS We developed a revised NDPH definition not excluding migraine features (NDPH-R), and applied it to consecutive patients seen at the Montefiore Headache Center. We divided this group into patients meeting ICHD-2 criteria (NDPH-ICHD) and those with too many migraine features for ICHD-2 (NDPH-mf). We compared clinical and demographic features in these groups, identifying 3 prognostic subgroups: persisting, remitting, and relapsing-remitting. Remitting and relapsing-remitting patients were combined into a nonpersisting group. RESULTS Of 71 NDPH-R patients, 31 (43.7%) also met NDPH-ICHD-2 criteria. The NDPH-mf and the NDPH-ICHD-2 groups were similar in most clinical features though the NDPH-mf group was younger, included more women, and had a higher frequency of depression. The groups were similar in the prevalence of allodynia, triptan responsiveness, and prognosis. NDPH-R prognostic subforms were also very similar, although the persisting subform was more likely to be of white race, to have anxiety or depression, and to have a younger onset age. CONCLUSIONS Current International Classification of Headache Disorders (ICHD)-2 criteria exclude the majority of patients with primary headache unremitting from onset. The proposed criteria for revised new daily-persistent headache definition not excluding migraine features (NDPH-R) classify these patients into a relatively homogeneous group based on demographics, clinical features, and prognosis. Both new daily-persistent headache with too many migraine features for ICHD-2 and new daily-persistent headache meeting ICHD-2 criteria include patients in equal proportions that fall into the persisting, remitting, and relapsing-remitting subgroups. Our criteria for NDPH-R should be considered for inclusion in ICHD-3.
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Affiliation(s)
- M S Robbins
- The Montefiore Headache Center, 1575 Blondell Avenue, Suite 225, Bronx, NY 10461, USA.
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Post-infectious new daily persistent headache may respond to intravenous methylprednisolone. J Headache Pain 2010; 11:59-66. [PMID: 19936615 PMCID: PMC3452180 DOI: 10.1007/s10194-009-0171-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 10/27/2009] [Indexed: 12/19/2022] Open
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.
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New daily persistent headache. Headache 2010. [DOI: 10.1017/cbo9780511750472.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Baron EP, Rothner AD. New Daily Persistent Headache in Children and Adolescents. Curr Neurol Neurosci Rep 2010; 10:127-32. [PMID: 20425237 DOI: 10.1007/s11910-010-0097-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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