Varicella-zoster virus and exertional headache: Evidence of viral vasculopathy in Valsalva maneuver-related headache syndrome

Exertional headache is one entity of Valsalva maneuver-related headache syndrome. It is usually idiopathic, but has occasionally been reported to be associated with secondary causes. However, central nervous system infection has not been mentioned before. We encountered a young man who suffered an isolated exertional headache and was found to have an active varicella-zoster virus central nervous system infection without typical intracranial hypertension or outfl ow obstruction. Intracranial vasoconstriction was detected during headache when the patient performed acute lifting or heavy exertion. The fi ndings in this patient suggest a specifi c relationship between varicella-zoster virus-related vasculopathy and exertional headache from other Valsalva maneuver-related headache syndrome. Neurology Asia 2011; 16(4) : 345 – 348 Address correspondence to: Hsin-Ling Yin, MD., Department of Pathology, Kaohsiung Medical University Hospital, 100 Shih Chuan 1st Road, San-Min District, Kaohsiung 807, Taiwan. Tel: +886-7-3121101; e-mail: [email protected] INTRODUCTION Exertional headache is one entity of Valsalva maneuver-related headache (VMRH) syndrome, with a lifetime prevalence of 1%. Secondary disorders, such as subarachnoid hemorrhage, arterial dissection, brain metastasis, pansinusitis, Arnold-Chiari malformation, platybasia, subdural hematomas, Eagle syndrome, acute myocardial infarction, and coronary artery disease (or cardiac cephalgia) have been reported in 10% to 42% of exertional headache patients. Conversely, the pathophysiology is still unknown in over half of exertional headache patients. Herein, we report a patient who suffered an isolated headache with exertion that was compatible with exertional headache associated with a varicella-zoster virus (VZV) central nervous system infection. The role of VZV-related vasculopathy in exertional headache is discussed.