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Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke
  1. C Di Lorenzo1,2,
  2. A Ambrosini1,
  3. G Coppola2,3,
  4. F Pierelli1,2
  1. 1
    Headache Clinic, IRCCS INM Neuromed, Pozzilli, Italy
  2. 2
    University Centre for Adaptive Disorders and Headache (UCADH), and Department of Neurology and ORL, and University Centre for Adaptive Disorders and Headache (UCADH), University of Rome “La Sapienza”, Polo Pontino, Latina, Italy
  3. 3
    GB Bietti Eye Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
  1. Dr C Di Lorenzo, Headache Clinic, IRCCS INM Neuromed Via Atinense, 18–86077–Pozzilli (IS), Italy; cherub{at}

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The most severe condition among the group of heat stress disorders is heat stroke (HS). It may be divided into two forms: classic and exertional. The former is due to environmental heat exposure and characterised by hyperthermia (above 40°C) and neurological dysfunction (headache, delirium, convulsions and coma). Exertional HS affects subjects performing strenuous exercise in heat environmental conditions and is characterised by more severe symptoms than the classic form. Residual neurological defects have been reported in up to 20% of exertional HS survivors.1

Although headache is reported among HS symptoms, the International Classification of Headache Disorders-second edition (ICHD-II) did not report secondary forms from heat exposure.2

Here we report the case of a patient who developed a headache clinical picture, fulfilling the diagnostic criteria for new daily persistent headache (NDPH) after an exertional HS.

Case report

A 45-years-old Caucasian woman came to our outpatient headache clinic with a history of chronic headache. Eighteen months before, she presented with an abrupt loss of consciousness during a prolonged physical exercise (trekking), performed at noon on a very hot summer’s day. She received initial treatment at an emergency department where hyperthermia, hypotension, lactic acidosis, breath alkalosis and electrolytic imbalance were observed. The diagnosis was exertional HS and she underwent cooling treatment and rehydration. …

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  • Competing interests: None.

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