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

Todd D. Rozen, Jennifer L. Beams

Research output: Contribution to journalArticle

7 Scopus citations


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.

Original languageEnglish (US)
Article number100
Pages (from-to)1-4
Number of pages4
JournalJournal of Headache and Pain
Issue number1
StatePublished - Jan 1 2013



  • Acalculia
  • New daily persistent headache
  • Nimodipine
  • Reversible cerebral vasoconstriction syndrome
  • Thunderclap headache
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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