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.