Post-infectious new daily persistent headache may respond to intravenous methylprednisolone |
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Authors: | Sanjay Prakash Nilima D Shah |
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Institution: | (1) Department of Neurology, Medical College, SSG Hospital, Baroda, Gujarat, 390001, India;(2) Department of Psychiatry, Medical College, Baroda, Gujarat, 390001, India;(3) O-19, Doctor’s Quarter, Jail Road, Baroda, Gujarat, 390001, India |
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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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Keywords: | Headache New daily persistent headache Chronic daily headache Post infectious illness Corticosteroids Methyl prednisolone |
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