Case report: Therapeutic response for new daily persistent headache by a tumor necrosis factor alpha antagonist, lithium

New daily persistent headache (NDPH) is an uncommon, treatment-resistant primary headache disorder that was first describe by Vanast in 1986 as a benign syndrome. Elevated TNF-alpha levels on CSF of NDPH patients as a possible cause of this disease. TNF-alpha inhibitors like doxycycline, venlafaxine...

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Bibliographic Details
Published in:Cephalalgia reports 2021, Vol.4
Main Authors: Bancalari, Ernesto M, Wicht, Astrid
Format: Article
Language:English
Subjects:
Astrocytes
Case reports
Doxycycline
Glycogen
Glycogen synthase kinase 3
Headache
Headaches
Inflammation
Interleukin 1
Interleukin 6
Lithium
Microglia
Montelukast
Necrosis
Patients
TNF inhibitors
Tumor necrosis factor-TNF
Tumor necrosis factor-α
Venlafaxine
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Summary:New daily persistent headache (NDPH) is an uncommon, treatment-resistant primary headache disorder that was first describe by Vanast in 1986 as a benign syndrome. Elevated TNF-alpha levels on CSF of NDPH patients as a possible cause of this disease. TNF-alpha inhibitors like doxycycline, venlafaxine and montelukast have been used in the past with relative good success. Lithium, used in Cluster Headache, has anti-inflammatory effects by inhibition of glycogen synthase kinase-3 (GSK3). This mechanism of action reduces production of inflammatory IL-6, IL-1 beta and TNF-alpha production by microglia, astrocytes and other immune cells. We report a NDPH patient that responded successfully to the administration of lithium after trying multiple treatments. We propose lithium, a TNF-alpha Inhibitor, as an effective treatment for refractory cases of NDPH.
ISSN:2515-8163
2515-8163
DOI:10.1177/25158163211000316