Skip to main content

Advertisement

Log in

Headache in Drug-Induced Aseptic Meningitis

  • Secondary Headache (M Robbins, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Drug-associated headache is a quite common phenomenon, e.g. as a side effect of distinct substances such as nitric oxide or as a result of medication overuse of analgesic drugs. A different drug-associated headache entity is headache in drug-induced aseptic meningitis (DIAM). This is a rare disorder and only described in few case reports or smaller case series. One of the main clinical features of DIAM despite fever is headache. Based on the literature, no typical or even pathognomonical clinical presentation of this headache entity can be described. Sometimes, migrainous features might be present, and treatment response to triptans was reported in single case reports. Headache in DIAM seems to be emerging from sterile meningeal inflammation, which is suggested to represent the underlying pathology in DIAM. Headache in DIAM usually ceases when treated sufficiently, mainly through termination or withdrawal of the causing agent. Migraine as a predisposing factor of DIAM has been discussed previously but remains unproven.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  2. Auriel E, Regev K, Korczyn AD. Nonsteroidal anti-inflammatory drugs exposure and the central nervous system. Handb Clin Neurol. 2014;119:577–84. This chapter summarizes the relationship between NSAIDs and aseptic meningitis and the analysis of possible pathophysiological mechanisms of this disease.

    PubMed  Google Scholar 

  3. Bruner KE, Coop CA, White KM. Trimethoprim-sulfamethoxazole-induced aseptic meningitis—not just another sulfa allergy. Ann Allergy Asthma Immunol. 2014;113:520–6. The authors give a good overview over the current knowledge on aseptic meningitis attributed to trimethoprim-sulfamethoxazole, which is the most common antibiotic causing aseptic meningitis. Therefore, they evaluated 41 patient histories.

    Article  CAS  PubMed  Google Scholar 

  4. Simms KM, Kortepeter C, Avigan M. Lamotrigine and aseptic meningitis. Neurology. 2012;78:921–7.

    Article  CAS  PubMed  Google Scholar 

  5. Morís G, Garcia-Monco JC. The challenge of drug-induced aseptic meningitis revisited. JAMA Intern Med. 2014;174:1511–2. The authors summarize the current knowledge on drug-induced aseptic meningitis, especially regarding clinical presentation after intake of different substance classes.

    Article  PubMed  Google Scholar 

  6. Moreno-Ancillo A, Gil-Adrados AC, Jurado-Palomo J. Ibuprofen-induced aseptic meningoencephalitis confirmed by drug challenge. J Investig Allergol Clin Immunol. 2011;21:484–7.

    CAS  PubMed  Google Scholar 

  7. Shahien R, Vieksler V, Bowirrat A. Amoxicillin-induced aseptic meningoencephalitis. Int J Gen Med. 2010;3:157–62.

    CAS  PubMed Central  PubMed  Google Scholar 

  8. Olin JL, Gugliotta JL. Possible valacyclovir-related neurotoxicity and aseptic meningitis. Ann Pharmacother. 2003;37:1814–7.

    Article  PubMed  Google Scholar 

  9. Redman RC, Miller JB, Hood M, DeMaio J. Trimethoprim-induced aseptic meningitis in an adolescent male. Pediatrics. 2002;110:e26.

    Article  PubMed  Google Scholar 

  10. Prokhorov S, Khanna S, Alapati D, Pallimalli SL. Subcutaneous sumatriptan relieved migraine-like headache in two adolescents with aseptic meningitis. Headache. 2008;48:1235–6.

    Article  PubMed  Google Scholar 

  11. Vollono C, Capuano A, Lazzareschi I, Ruggiero A, Attinà G, Maurizi P, et al. Acute aseptic meningitis inducing migraine-like attacks in a 7-year-old child. Eur J Neurol. 2006;13:552.

    Article  CAS  PubMed  Google Scholar 

  12. Stamboulis E, Spengos M, Rombos A, Haidemenos A. Aseptic inflammatory meningeal reaction manifesting as a migrainous syndrome. Headache. 1987;27:439–41.

    Article  CAS  PubMed  Google Scholar 

  13. Moris G, Garcia-Monco JC. The challenge of drug-induced aseptic meningitis. Arch Intern Med. 1999;159:1185–94.

    Article  CAS  PubMed  Google Scholar 

  14. Lamonte M, Silberstein SD, Marcelis JF. Headache associated with aseptic meningitis. Headache. 1995;35:520–6.

    Article  CAS  PubMed  Google Scholar 

  15. Wambulwa C, Bwayo S, Laiyemo AO, Lombardo F. Trimethoprim-sulfamethoxazole-induced aseptic meningitis. J Natl Med Assoc. 2005;97:1725–8.

    PubMed Central  PubMed  Google Scholar 

  16. Greenberg LE, Nguyen T, Miller SM. Suspected allopurinol-induced aseptic meningitis. Pharmacotherapy. 2001;21:1007–9.

    Article  CAS  PubMed  Google Scholar 

  17. Mifsud AJ. Drug-related recurrent meningitis. J Infect. 1988;17:151–3.

    Article  CAS  PubMed  Google Scholar 

  18. Green MA, Abraham MN, Horn AJ, Yates TE, Egbert M, Sharma A. Lamotrigine-induced aseptic meningitis: a case report. Int Clin Psychopharmacol. 2009;24:159–61.

    Article  PubMed  Google Scholar 

  19. Escalante A, Stimmler MM. Trimethoprim-sulfamethoxasole induced meningitis in systemic lupus erythematosus. J Rheumatol. 1992;19:800–2.

    CAS  PubMed  Google Scholar 

  20. Gordon MF, Allon M, Coyle PK. Drug-induced meningitis. Neurology. 1990;40:163–4.

    Article  CAS  PubMed  Google Scholar 

  21. Periard D, Mayor C, Aubert V, Spertini F. Recurrent ibuprofen-induced aseptic meningitis: evidence against an antigen-specific immune response. Neurology. 2006;67:539–40.

    Article  CAS  PubMed  Google Scholar 

  22. Berliner S, Weinberger A, Shoenfeld Y, Sandbank U, Hazaz B, Joshua H, et al. Ibuprofen may induce meningitis in (NZB X NZW)F1 mice. Arthritis Rheum. 1985;28:104–7.

    Article  CAS  PubMed  Google Scholar 

  23. Lafferty TE, DeHoratius RJ, Smith JB. Aseptic meningitis as a side effect of intravenous immune gammaglobulin. J Rheumatol. 1997;24:2491–2.

    CAS  PubMed  Google Scholar 

  24. Sekul EA, Cupler EJ, Dalakas MC. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: frequency and risk factors. Ann Intern Med. 1994;121:259–62.

    Article  CAS  PubMed  Google Scholar 

  25. Levy D. Migraine pain, meningeal inflammation, and mast cells. Curr Pain Headache Rep. 2009;13:237–40.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dagny Holle reports a grant from Allergan.

Mark Obermann declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dagny Holle.

Additional information

This article is part of the Topical Collection on Secondary Headache

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holle, D., Obermann, M. Headache in Drug-Induced Aseptic Meningitis. Curr Pain Headache Rep 19, 29 (2015). https://doi.org/10.1007/s11916-015-0505-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0505-0

Keywords

Navigation