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.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.
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.
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.
Simms KM, Kortepeter C, Avigan M. Lamotrigine and aseptic meningitis. Neurology. 2012;78:921–7.
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.
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.
Shahien R, Vieksler V, Bowirrat A. Amoxicillin-induced aseptic meningoencephalitis. Int J Gen Med. 2010;3:157–62.
Olin JL, Gugliotta JL. Possible valacyclovir-related neurotoxicity and aseptic meningitis. Ann Pharmacother. 2003;37:1814–7.
Redman RC, Miller JB, Hood M, DeMaio J. Trimethoprim-induced aseptic meningitis in an adolescent male. Pediatrics. 2002;110:e26.
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.
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.
Stamboulis E, Spengos M, Rombos A, Haidemenos A. Aseptic inflammatory meningeal reaction manifesting as a migrainous syndrome. Headache. 1987;27:439–41.
Moris G, Garcia-Monco JC. The challenge of drug-induced aseptic meningitis. Arch Intern Med. 1999;159:1185–94.
Lamonte M, Silberstein SD, Marcelis JF. Headache associated with aseptic meningitis. Headache. 1995;35:520–6.
Wambulwa C, Bwayo S, Laiyemo AO, Lombardo F. Trimethoprim-sulfamethoxazole-induced aseptic meningitis. J Natl Med Assoc. 2005;97:1725–8.
Greenberg LE, Nguyen T, Miller SM. Suspected allopurinol-induced aseptic meningitis. Pharmacotherapy. 2001;21:1007–9.
Mifsud AJ. Drug-related recurrent meningitis. J Infect. 1988;17:151–3.
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.
Escalante A, Stimmler MM. Trimethoprim-sulfamethoxasole induced meningitis in systemic lupus erythematosus. J Rheumatol. 1992;19:800–2.
Gordon MF, Allon M, Coyle PK. Drug-induced meningitis. Neurology. 1990;40:163–4.
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.
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.
Lafferty TE, DeHoratius RJ, Smith JB. Aseptic meningitis as a side effect of intravenous immune gammaglobulin. J Rheumatol. 1997;24:2491–2.
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.
Levy D. Migraine pain, meningeal inflammation, and mast cells. Curr Pain Headache Rep. 2009;13:237–40.
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Dagny Holle reports a grant from Allergan.
Mark Obermann declares no potential conflicts of interest.
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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
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DOI: https://doi.org/10.1007/s11916-015-0505-0