A case study of CGRP receptor blockade In New Daily Persistent Headache secondary to Zika virus.

Objective: New Daily Persistent Headache (NDPH) is a distinct clinical syndrome which can represent a primary headache disorder or be secondary in aetiology, such as an antecedent viral trigger. NDPH can be bland or be accompanied by migrainous symptoms like photophobia; it's as yet unclear how the endophenotype influences therapeutic response. There are two published cases of a flavivirus, Dengue, causing NDPH, but not yet Zika virus (ZV). This single case report of NDPH secondary to ZV aims to track the clinical progress of multiple medical and interventional management strategies. Method(s): The clinical notes were reviewed regarding the headache semiology, other symptoms of note and comorbidities. The patient was investigated to ensure there were no persistent foci of infection utilising magnetic resonance imaging and repeated lumbar puncture. Response to treatments were measured with a headache diary and Headache Impact Test Score (HIT-6). Result(s): This 63 year-old man acquired ZV infection in the Cook Islands in March 2014, confirmed with a positive ZV neutralisation test. Prior to infection there was no personal or family history of migraine. During follow-up investigations there was no demonstrable evidence of ongoing infection. His headaches with migrainous features were not responsive to the triptan class of medications. Since the acute presentation, headache persisted every hour of every day, irrespective of any of the 17 prophylactic treatments trialled. Erenumab 140 mg every 28 days was the only treatment to give a 50% reduction in the migraine days-defined as moderate to severe headache associated with sensitivity to light and noise and movement sensitivity-at both 3 and 6 month follow-up. His ability to exercise and function improved significantly. The HIT-6 score improved from a baseline of 64 to 56 at three months and 36 at six months subsequent to the initiation of erenumab treatment. Conclusion(s): This is the first reported case of ZV triggerin