Department of Neurology, Geisinger Health System, Geisinger Headache Clinic, MC 37-32, 1000 East Mountain Blvd, Wilkes-Barre, PA 18711, USA.
J Headache Pain. 2013 Dec 23;14(1):100. doi: 10.1186/1129-2377-14-100.
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.
目前，新的每日持续性头痛只是一组基于其发作模式时间特征相关联的病症。如果新的每日持续性头痛是一种像偏头痛一样的真正独特的综合征，那么我们需要开始定义具有特定有效治疗方法的亚型，就像偏头痛亚型一样。我们提出了我们认为是新的每日持续性头痛的第一个被认可的亚型，其起始为霹雳头痛发作。一位患者出现了 13 个月的每日头痛病史，从霹雳头痛开始，同时伴有持续的计算障碍。所有针对继发性病因的神经影像学研究均为阴性。尼莫地平迅速且完全缓解了她的头痛和相关的神经系统症状。我们提出，这种新的每日持续性头痛的亚型是由 CSF 肿瘤坏死因子-α水平的快速升高引起的，导致大脑动脉血管痉挛，随后出现霹雳头痛，然后是持续或近乎持续的大脑动脉血管痉挛导致持续性每日头痛。尼莫地平不仅抑制大脑动脉血管痉挛，还抑制肿瘤坏死因子-α的产生，似乎是这种新的每日持续性头痛的特定治疗方法。
