Case of thunderclap (severe sudden onset) headache associated with inability to do calculations (acalculia) that persisted for 13 months despite interventions. Nimodipine 30 mg, initially bid, then od, relieve headache. It was felt that cytokines and vasospasms persisted the headaches. Nimodipine is a TNF/interleukin inhibitor as well as an antispastic drug used in subarachnoid hemorrhage cases – which is why it was thought to miraculously work.
J Headache Pain. 2013 Dec 23;14(1):100.
New daily persistent headache with a thunderclap headache onset and complete response to Nimodipine (A new distinct subtype of NDPH).
Rozen TD, Beams JL.
- 46 yr old lady with 10/10 sudden headache while playing bingo
- subsequently left with chronic lower grade (4-5/10) headache associate nausea and photophobia
- Imagining negative
- had subsequent trouble with numbers – simple addition, subtraction and even writing down phone numbers – acalculia
- “she had right greater occipital notch and occiput based pain to palpation although she stated this palpable tenderness was not her true pain hich was “deep” to the skull.”
- no aggravating/alleviating factors
- felt it did not qualify as hemicrania
- within 4 days of Nimodipine 30 mg bid, headache disappeared – patient was able to eventually wean to 1/day but could not stop med without recurrence.
- It was felt htat vasospasm started the headache and persistent vasospasm coupled with elevated Tumor Necrosis Factor (TNF) cytokine production persisted it. Nimodipine is unique in that it inhibits both.
Comment – have seen such a protracted case though that one associated with patch nummular headache. Nimotop is $10/pill so not for faint of heart (or pocket book)…Needs to be tried on all cases of this nature…