Bath-Related Headache

Abstract

Bath-related headache (BRH) is a rare primary headache syndrome. We present our experience over seven years and review all reported cases of BRH. Thirteen patients, including six from our group, are described. BRH occurred exclusively in middle-aged or elderly Oriental women (mean age 51 years, range 32-67. Hong Kong 6 cases, Taiwan 4 cases, Japan 3 cases). The typical presentation was a uniphasic cluster of severe headache recurrently triggered by bathing or other activities involving contact with water. Each attack lasted 30 min to 30 h. Onset was hyperacute, consistent with that of thunderclap headache. Reversible multisegmental cerebral vasoconstriction was found in two patients. No underlying secondary causes were identified. Response to acute treatment was generally unsatisfactory, but headache could be prevented by avoiding the specific trigger(s). BRH runs a self-limiting course; all patients remitted within three months after onset. Nimodipine may shorten the duration of illness.

Reversible cerebral angiopathy

“…The effect of the drug is attributed to the relaxation of the smooth muscle of arterial blood vessel walls. However, the clinical effect of nimodipine in RCA probably does not result from vasospasm removal only since the drug improved thunderclap headache in some patients without arterial abnormalities [4][5][6]. Interestingly, oral nimodipine was sufficient to improve headache in such patients free of vasospasm.…”

“…IV nimodipine (2 mg/h) was started and headache improved a few hours later. Efficacy of nimodipine was also reported in 3 patients with severe headaches and intracranial vasospasms, under the appellation of primary thunderclap headache [4] or bath-related headache [4,6]. In fact, the diagnosis of RCA can be confidently made in these cases.…”

“…Lu et al [5] reported a 46-year-old woman with thunderclap headache who partially responded to oral nimodipine (360 mg/d) but headache disappeared under IV nimodipine (2 mg/h) treatment. Finally, Mak et al [6] described a 50-yearold woman with bath-related headache for whom oral nimodipine (360 mg/d) seemed to shorten duration of the headache. IV nimodipine (48 mg/d) was also delivered in two young women with postpartum RCA who rapidly improved [3].…”

Bath-Related Headache-The Second Case in South America

“…In recent years, some descriptions of a new headache have appeared in which the warm stimulus applied on the head was the one provoking the headache. The onset of this headache is more frequent when the patient wets the head with hot water [4,[6][7][8][9]11], but this headache disorder may be triggered by the patient pouring hot water over his/her body [1,5,6] or soaking in hot water [1,10].…”

“…To date, most cases reported (22/24; 91.7%) in the literature have occurred in the Asian population of five countries: China (8 cases) [3,4], Japan (4 cases) [1,5], Taiwan (5 cases) [6,7], Turkey (4 cases) [8] and Korea (1 case) [9]. There is only one case in Europe (Spain) [10] and another in South America (Brazil) [11].…”