Headache and Painful Lymphadenopathy in Extracranial or Systemic Infection: Etiology of New Daily Persistant Headaches.

Abstract

From 108 cases of new daily persistent headaches, clinical or laboratory evidence was found suggesting extracranial or systemic infections in: 28 cases (25.9%) of gastrointestinal mainly Salmonella, 28 (25.9%) urinary Coli, 16 (14.8%) Streptococcal, 4 (3.7%) each ofEpstein Barr virus or Toxoplasma, and 1 (0.9%) each of Herpes Zoster or pneumonia. A group of26 (24.1%) showed high Proteus OXtiter or clinical adenoviral involvement. All had normal neurological examinations plus selective negative neuroimaging or spinal taps. The meanheadache duration was 13.8 days, and mean age 28.8 years. Prominent symptoms were fever in 37 (34.2%) cases, nausea/ vomiting in 30 (27 %) and vertigo in 17 (15.7 % ). Diarrhea, dysuria, and abdominal discomfort were rare. Headache was a solitary symptomin 36 (33.3%). The predominant sign was painful cervical lymphadenopathy in 61 (56.5%). These cases represent 1.2% of our 9060 neurology patients. (Internal Medicine 32: 530-532, 1993)

New daily persistent headache in children and adults

“…However, up to 40% of their patients did not have a known trigger. In addition to the risk factors previously mentioned, the transformation of an episodic headache into a chronic headache (or the onset of NDPH) in adults has also been associated with hypothyroidism, hypertension, consumption of alcohol more than 3 times per week, analgesic overuse, daily consumption of caffeine [15], multiple types of infections [16], and stressful life events [17]. A particularly interesting observation is that many patients will wake up after extracranial surgery (such as an appendectomy) with NDPH [13,18,19].…”

“…Diaz-Mitoma et al [20] noted that 84% of patients with NDPH had evidence of "active" EpsteinBarr virus infection. However, other infections can also provoke NDPH [16], and 43% of the patients in the childhood NDPH study reported some type of infection at the onset of symptoms [13]. Meineri et al [18] reported NDPH associated with recent seroconversion to herpes simplex virus or cytomegalovirus.…”

New Daily Persistent Headache in Children and Adolescents

“…It is more common in females, with the female/male ratio in adults at 2.5:1 [5] and in children and adolescents at 1.8:1 [4•]. It has an earlier age of onset in women (ages [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] than in men (ages 26-45) [5]. One study of 680 pediatric headache clinic patients reported 189 (28%) with tension-type headache, 34 of whom met NDPH criteria [7].…”

“…The pathophysiology of NDPH is unknown, although some general associations have been made with infection, extracranial surgery, stressful life events, hypothyroidism, hypertension, analgesic overuse, and frequent caffeine use [5,[19][20][21]. In one study of 34 pediatric headache patients with NDPH, five (15%) had a preceding infection, five (15%) had a preceding mild to moderate head injury, and four had significant psychosocial issues [7].…”

“…1 Onset of chronic tensiontype headache (CTTH) and chronic migraine (CM) compared with that of new daily persistent headache (NDPH). CTTH and CM both have a gradual increase in frequency (A), whereas NDPH has an abrupt onset (B) cytomegalovirus, Salmonella, adenovirus, Toxoplasma, and herpes zoster [1,20,24]. Given the variety of infectious associations, it has been postulated that the nonspecific inflammatory response initiated by the infection, rather than the infectious agent itself, may be the trigger [6].…”