New daily persistent headache with a thunderclap headache onset and complete response to Nimodipine (A new distinct subtype of NDPH)

Abstract

At present new daily persistent headache is just a group of conditions that are connected based on the temporal profile of their mode of onset. If new daily persistent headache is a true distinct syndrome like migraine then we need to start to define subtypes that have specific effective treatments such has been noted for migraine sub-forms. We present what we believe is the first recognized subtype of new daily persistent headache that which starts with a thunderclap headache onset. A patient presented with a 13 month history of a daily headache from onset which initiated as a thunderclap headache along with persistent acalculia. All neuroimaging studies for secondary causes were negative. Nimodipine rapidly and completely alleviated her headache and associated neurologic symptoms. We propose that this subtype of new daily persistent headache is caused by a very rapid increase in CSF tumor necrosis factor alpha levels leading to cerebral artery vasospasm with a subsequent thunderclap headache, then continuous or near continuous cerebral artery vasospasm leading to a persistent daily headache. Nimodipine which not only inhibits cerebral artery vasospasm but also tumor necrosis factor alpha production appears to be a specific treatment for this distinct subtype of new daily persistent headache.

An RCVS Spectrum Disorder? New Daily Persistent Headache Starting as a Single Thunderclap Headache (3 New Cases)

“…All patients were females with an average age of headache onset of 46 years (range 37‐58 years). A single representative case will be presented as well as a table documenting the demographics of the other cases that have been diagnosed including the original case published previously …”

“…One such unique subtype of NDPH is that which starts with a single thunderclap headache. To date, there is just one case patient documented who was successfully treated with nimodipine . We now present 3 new cases with the suggestion that this is part of a reversible cerebral vasoconstriction syndrome (RCVS) spectrum disorder.…”

New daily persistent headache: a systematic review on an enigmatic disorder

“…He proposed this case as a distinct subtype of NDPH caused by continuous cerebral artery vasospasm due to rapid increase in CSF TNF-α levels. This is the only report of efficacy of nimodipin in NDPH [38].…”

The Three T's of NDPH (How Clinical Observations Have Led to Improved Treatment Outcomes)

“…The key has been the recognition that NDPH is not a single entity, but a disorder caused by multiple disparate conditions. These varying disorders which the author suggests can be subtyped by the “Three Ts Model”: Triggering event, Trendelenburg response, and Thunderclap headache (define the first ever headache that heralded NDPH) allows us to place NDPH patients within subgroups . Those in the same subgroup most likely have similar if not the same underlying pathogenesis and based on that presumed knowledge a specific effective treatment regime can be established .…”