Relationship of anti-NMDA-receptor antibodies and patients with autoimmune encephalitis having new-onset headache
Autoimmune encephalopathies is most frequently observed in women than in men. It goes hand-in-hand with cognitive dysfunction as well as neuro-psychiatric symptoms. This research tested: (1) that autoimmune encephalitis is associated with new-onset headache, and (2) that the occurrence of headache is associated with the existence of anti-N-methyl-D-aspartate (NMDA)-receptor antibodies.
Antibody-mediated dysfunction of the glutamatergic system as depicted by the presence of anti-NMDA-receptor antibodies in some patients can be thought to be involved as per its pathophysiology.
A study has been conducted where patients with autoimmune encephalitis were analysed foregoing with a standardized interview for previous headache and headache associated with autoimmune encephalitis. The International Classification of Headache Disorders, second edition has classified the headache. The clinical and paraclinical discoveries were correlated with the phenomenon of headache.
Out of 40 patients, 19 with autoimmune encephalitis did not have a history of headache of which 9 suffered from encephalitis-associated headache. Out of these nine, seven had anti-NMDA-receptor antibodies in contrast to only two among the remaining 10 patients without new-onset headache (P = .023, odds ratio: 14, 95% confidence interval: 1.5; 127). Most of the patients reported severe headaches on more than 15 days/month and of brief interval. Three patients followed the International Headache Society criteria for migraine.
As per the conclusions, the new-onset headache is a relevant symptom in patients with autoimmune encephalitis who have no history of previous headache, especially in subgroup with anti-NMDA-receptor antibodies. This study further specifies a rigorous investigation for secondary headaches plus anti-NMDA-R antibodies for patients with new-onset headache and neuropsychiatric findings. Glutamatergic dysfunction may only sometimes be enough to trigger migraine-like attacks in non-migraineurs but it might be significant for creating head pain.