An interesting article titled “New Daily Persistent Headache As A Presenting Symptom Of Hashimoto’s Encephalopathy,” is written by Daniel E. Jacome and located over at http://www.webmedcentral.com/wmcpdf/Article_WMC00960.pdf. The article discusses Hashimoto’s encephalopathy (HE) which is a rare autoimmune neurological disorder and how patients with this disorder may present with a headache characteristic of new daily persistent headache or atypical hemicranias continua.
Patients of HE are said to have elevated serum titers of thyroid microsomal and antithyroglobulin antibodies. A reference is made to a past case of a woman who had such elevated antibodies and also a left sided headache and aphasia. The current article describes a case of a 50 year old man who had such elevated antibodies and also a persistent daily left sided headache with aphasia. Note that his brain MRI and MRA was normal.
In the article it is mentioned that the man is put on a indomethacin 2 week test as commonly done for hemicranias continua. He doesn’t respond to this and they then try intravenous methyl prednisolone which works well in providing headache relief. He later was put on intravenous immunoglobulin. He doesn’t take steroids on a long term basis and now commonly takes ibuprofen for his headache.
In the article the authors suggest a possible explanation for HE and headache
“Overtime it became apparent that many patients with HE were euthyroid. Subsequently, it was proposed that antibodies primary directed against the thyroid gland, “leaked” across the blood-brain barrier into the brain parenchyma, inducing an autoimmune lymphocytic response based on shared antigens between brain and thyroid….It is possible to speculate than in HE, an associated inflammatory response (asymmetric in this example) affecting the trigemino-vascular brain innervations, may result in peri-vascular nocioceptor activation and hemicrania continua.”
For patients who have a new daily persistent headache they may want to explore Hashimoto’s Encephalopathy as a possible alternative for their condition and have their CSF antibodies looked at. The article does note that the intravenous immunoglobulin alleviated the 50 year old man’s aphasia and cognitive impairment.