A 24-year-old woman experienced a postdural puncture headache following a labor epidural, recovered following bedrest, and was then without headache for 12 years. She then experienced sudden onset of daily, holocephalic headache persisting for 6 years prior to presentation. Pain reduced with prolonged recumbency. MRI brain, MRI myelography, and later bilateral decubitus digital subtraction myelography showed no cerebrospinal fluid (CSF) leak or CSF venous fistula, and normal opening pressure. Review of an initial noncontrast MRI myelogram revealed a subcentimeter dural outpouching at L3-L4, suspicious for a posttraumatic arachnoid bleb. Targeted epidural fibrin patch at the bleb resulted in profound but temporary symptom relief, and the patient was offered surgical repair. Intraoperatively, an arachnoid bleb was discovered and repaired followed by remission of headache. We report that a distant dural puncture can play a causative role in the long delayed onset of new daily persistent headache.

To describe the characteristics of patients with new-onset headache following SARS-CoV-2 infection.
SARS-CoV-2 infection leads to several neurological manifestations, and headache is a frequent and disabling symptom, both exacerbating pre-existing headache syndromes and causing new-onset ones.
Patients with new-onset headache after SARS-CoV-2 infection with consent to participate were included, while those ones with previous headaches were excluded. The temporal latency of headache after infection, pain characteristics, and concomitant symptoms were analysed. Moreover, the efficacy of acute and preventive medications was explored.
Eleven females (median age 37.0 [10.0-60.0] years old) were included. In most cases, headache onset occurred with the infection, the location of pain varied, and the quality was either pulsating or tightening. Headache was persistent and daily in 8 patients (72.7%), while it occurred in episodes in the remaining subjects. Baseline diagnoses were new daily persistent headache (36.4%), probable new daily persistent headache (36.4%), probable migraine (9.1%), and migraine-like headache secondary to COVID-19 (18.2%). Ten patients received one or more preventive treatments and six of them showed an improvement.
New-onset headache following COVID-19 is a heterogenous condition with uncertain pathogenesis. This type of headache can become persistent and severe, with a wide spectrum of manifestations (new daily persistent headache being the most represented one) and variable response to treatment.

OBJECTIVE: We aimed to determine the association between iron deficiency anemia and chronic daily headache.
METHODS: This case-control study was conducted in a tertiary care center in Dehradun, India. One hundred patients with chronic daily headache were randomly selected for the study with an equal number of controls. Subsets of chronic daily headache were diagnosed as per the 3rd edition of the International Classification of Headache Disorders. The study participants were assessed for iron deficiency anemia.
RESULTS: The mean age of the patients was 51.1 ± 22.1 years. Male: female ratio was 1:1.08. Chronic migraine was present in 62 (62%), tension-type headache in 23 (23%), and new daily persistent headache in 15 (15%) patients. The majority (96%) of patients had chronic daily headache of mild to moderate severity. Chronic daily headache was of long duration in all patients. Sixty-four (64%) patients had anemia of which 51 (51%) patients had iron deficiency anemia. Iron deficiency anemia showed a significant association with chronic daily headache (p < 0.001), but not with its type, subtype, and duration. Severe iron deficiency anemia had a significant association with the severity of chronic daily headache (p = 0.021). Serum iron, ferritin, total iron-binding capacity, and transferrin saturation also had a significant association with chronic daily headache (p < 0.05 for each), but not with its type, subtype, duration, and severity. Logistic regression analysis showed that iron deficiency anemia, total iron-binding capacity, and transferrin saturation had an independent association with chronic daily headache (p < 0.05 for each).
CONCLUSIONS: Iron deficiency anemia had an independent association with chronic daily headache. Severe iron deficiency anemia was related to the severity of chronic daily headache.

We have provided long-term data on clinically meaningful pain alleviation for drug-refractory headache disorders using occipital (ONS) and supraorbital nerve stimulation (SONS).
We performed a retrospective review of 96 patients with migraine, cervicogenic headache, cluster headache, neuropathic pain of the scalp, tension-type headache, and new daily persistent headache who had undergone ONS (61.5%), SONS (11.5%), or combined ONS plus SONS (27.1%) trial implantation and definitive implantation from 2007 to 2017. Changes in pain perception over time were monitored using the visual analog scale (VAS) for pain.
The cohort consisted of 60.4% women and 39.6% men, with a mean age of 46.9 ± 11.5 years and pain duration of 14 ± 14.1 years. Of the 96 patients, 65 (67.7%) were treatment responders to a trial (≥30% amelioration in the average or maximum VAS score for pain and/or number of headache days) that had lasted 22.5 ± 8.8 days. The reduction in their average VAS score for pain was to 37% ± 24.4% of baseline compared with 99.1% ± 24.1% of baseline for those without a response (P < 0.01). Of the 56 patients who had undergone implantation and had long-term follow-up data available for ≤10 years, 32 (57.1%) reported a ≥50% reduction in their average VAS score for pain. Four patients (6.5%) had requested hardware explantation. Stage II complications included 1 infection (1.6%) and 6 electrode dislocations (9.7%). The study limitations included the retrospective nature, lack of controls receiving placebo intervention, and randomization.
After careful patient selection according to a positive response to a trial of ONS and/or SONS, clinically meaningful long-term benefit was achieved in 57.1% of our patients with various chronic headache conditions.

BACKGROUND: Primary essential cutis verticis gyrata is a condition that usually affects healthy subjects associated to convoluted folds and furrows formed from thickened skin of the scalp resembling cerebriform pattern.
METHODS: we describe a case of association between primary essential cutis verticis gyrata and new daily persistent headache.
CONCLUSIONS: In our knowledge this is the first description of new daily persistent headache associated with primary essential cutis verticis gyrata. We think that primary essential cutis verticis gyrata could be considered as a possible trigger factor, never described before, for the development of new daily persistent headache.