New daily persistent headache: clinical and serological characteristics in a retrospective study

Abstract

We present a retrospective clinical study of 18 cases of new daily persistent headache (NDPH), a rare chronic headache, included in the fourth chapter of the II IHS classification; the pathophysiology of NDPH is unknown but a link with viral infections (especially Epstein-Barr virus (EBV)) has been suggested. Comparing our series with the other two published until now, we did not find any particular difference, as regards to clinical aspects. However, our laboratory tests show a recent herpes simplex virus infection in 42% and cytomegalovirus in 11% of cases; moreover we could not find any EBV infection. Our data suggest that viruses other than EBV can play a role in NDPH.

Clinical and prognostic subforms of new daily-persistent headache

“…Because of the report that many patients experience an antecedent flu-like illness, a postinfectious phenomenon has been postulated, 16 often attributed to Epstein-Barr virus 17 or other infections. 11 Our finding that NDPH patients can have their headache onset in a biphasic pattern during the beginning of spring and autumn could also impart a seasonal trigger, such as an infection, as a common inciting factor. However, though NDPH patients may have elevated CSF levels of a proinflammatory cytokine, tumor necrosis factor-␣, this does not seem related to having a history of an antecedent infection.…”

“…In an Italian series of 18 patients, 66% remitted within 24 months. 11 In our series, we did not follow all patients over a 24-month period, but over half of the patients with the persisting subform had continuing daily headache for 24 months or longer. Of the patients who remitted, 63.6% did so within 24 months.…”

“…In published case series, migraine features such as throbbing pain, nausea, vomiting, photophobia, and phonophobia are common. 5,10,11 Several series have used the original Silberstein-Lipton criteria, which only require an average of 15 or more days of monthly headache, 8 or modified ICHD-2 criteria (table 1). 5 The ICHD-2 criteria for NDPH are problematic as patients with otherwise typical NDPH are not easily classified in the presence of migraine features.…”

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].…”

“…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].…”