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Resolution of new daily persistent headache by a tumor necrosis factor alpha antagonist, Venlafaxine

Zeshan Tariq, Nathan Board, Alex Eftimiades, Ronnie Ibrahim
SAGE open medical case reports 2019, 7: 2050313X19847804
31105954
New daily persistent headache is a continuous, unremitting headache, notorious for its unresponsiveness to aggressive medical interventions. The underlying pathophysiology of new daily persistent headache is poorly understood resulting in unending, chronic pain. However, a prior study identified elevated tumor necrosis factor alpha within the cerebral spinal fluid of new daily persistent headache patients. Herein, we report on a patient who suffered with headache for 6 years failing to respond to over 20 different medical treatments, but found drastic improvement and eventual resolution with Venlafaxine. This drug binds to the 5-HT2A receptor inhibiting tumor necrosis factor alpha signaling. Therefore, we hypothesize a chronic inflammatory mechanism driving new daily persistent headache pathology.

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