Hi there,

Since we have some new members, I thought I would post this article
(it's also in the Files section. It's the only article I've found
that specifically talks about treatemnt of postmeningitis headache.

Also, I've just uploaded a bunch of new links from my database that
may be of interest/help to you.

...Laura

Ask the Experts about Headache
from Medscape Neurology & Neurosurgery

http://www.medscape.com/viewarticle/413709


Treatment of Headache After Viral Meningitis?

Question
What is the recommended treatment for protracted intractable headache
following viral meningitis? CT scan and other tests show no
complicating factors.



Response from Randolph Warren Evans, MD
Clinical Associate Professor in the Department of Neurology at the
University of Texas at Houston Medical School and Clinical Associate
Professor in the Department of Family and Community Medicine at
Baylor College of Medicine.





First, I would want to confirm the diagnosis of acute viral
meningitis, even though it has resolved. Even with a normal CT scan,
an MRI scan of the brain can further exclude a parameningeal focus,
meningeal enhancement, low-grade neoplasm, or paranasal sinusitis
(such as ethmoid or sphenoid). A lumbar puncture will determine
whether the CSF has indeed returned to normal. I presume there is no
evidence of any other systemic disease such as HIV, Lyme,
sarcoidosis, cancer, or collagen vascular disease, or drug-induced
meningitis (eg, due to nonsteroidal anti-inflammatory drugs [NSAIDs],
antibiotics such as trimethoprim/sulfamethoxazole, carbamazepine, or
ranitidine).[1]
Neufeld and associates[2] provide an excellent description of the
natural history of "postmeningitis headache." They reported on 70
patients from 5-78 years of age with acute meningitis (viral in 53
and bacterial in 17) who were interviewed about 5 years after the
initial illness. After recovery from meningitis, 54% of those with
previous headache reported increased frequency of the headache, and
37% experienced new-onset postmeningitis headache. However, only 21%
of the new-onset headache group experienced the postmeningitis
headaches within the first year. Patients who developed
postmeningitis headache were significantly younger than those who did
not. Forty-six percent of patients with meningitis reported headaches
on follow-up compared with 26% of age- and sex-matched controls. New-
onset daily headache has also been associated with Epstein-Barr virus-
induced immune changes.[3]

Treatment of postmeningitis headache is the same as treatment of any
other chronic daily headache. Could medication rebound be
contributing to the headaches? If some of the headaches meet migraine
criteria, a triptan could be tried for symptomatic treatment. Other
symptomatic medications that might be of benefit include baclofen,
NSAIDs, and tizanidine. Preventive medications for chronic daily
headache could also be tried such as tricyclics, venlafaxine,
valproic acid, and topiramate. Nonmedication approaches that could be
tried include biofeedback, massage, and acupuncture. The patient
might also benefit from hospitalization for a few days for a trial of
intravenous DHE and/or valproate sodium.[4]



Posted 12/19/2000


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References
Evans RW. Other secondary headaches and associated disorders. In:
Evans RW, Mathew NT, eds. Handbook of Headache. Philadelphia:
Lippincott-Williams & Wilkins; 2000:chap 13.
Neufeld MY, Treves TA, Chistik V, Korczyn AD. Postmeningitis
headache. Headache. 1999;39:132-134.
Vanast WJ, Diaz-Mitoma F, Tyrrell DL. Hypothesis: chronic benign
daily headache is an immune disorder with a viral trigger. Headache.
1987;27:138-142.
Mathew NT, Kailsaam J. Repetitive intravenous administration of
valproate sodium in intractable migraine: comparison with intravenous
dihydroergotamine (DHE). Neurology. 2000;54(suppl 3):A22.




Medscape Neurology & Neurosurgery 2(2), 2000. © 2000 Medscape