Paper
Etiology and Treatment of New Daily Persistent Headache
Published Sep 1, 2001 · R. Evans, T. Rozen
Headache: The Journal of Head and Face Pain
33
Citations
1
Influential Citations
Abstract
CLINICAL HISTORY A 37-year-old woman was seen for evaluation of a new-onset daily headache of 36 days’ duration. At the onset of the headache, she also had a sore throat without fever for 3 days. An ear, nose, and throat physician started her on an antibiotic. She described a rather constant generalized pressure and squeezing sensation with light sensitivity which was intermittently severe any time of the day. On one occasion 2 weeks previously, she had nausea. She had no fever and other than the initial sore throat, no systemic symptoms. Her family physician prescribed Fioricet (two to three per day for 2 weeks) which dulled the headaches, naproxen, and citalopram. Three years prior to evaluation, she had frequent, mild, bifrontal, pressure-type headaches for about a year, which resolved after quitting her job. She also had two bad headaches during the prior 2 years which consisted of a visual aura followed by a bifrontal throbbing with light sensitivity which resolved with sleep. Past medical history included resection of a noninvasive melanoma 10 months previously. General and neurological examinations were normal. A magnetic resonance imaging (MRI) scan of the brain with and without contrast was normal. A lumbar puncture revealed a normal opening pressure and normal cerebrospinal fluid (CSF). After 2 days of treatment in hospital with intravenous metoclopramide, dihydroergotamine, and valproate every 8 hours, the headaches completely resolved. Questions.— Could the upper respiratory infection without apparent meningitis have triggered newonset daily headache? How often are causes of new daily persistent headache (NDPH) identified? What treatment do you recommend?
Case ReportNew daily persistent headaches can be resolved with intravenous metoclopramide, dihydroergotamine, and valproate treatment, which is often recommended for acute cases.
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