Anne Csere, DO; Soma Sahai-Srivastava, MD The Development of New Daily Persistent Headache after Electronic Cigarette Use in an Adolescent Anne Csere, DO; Soma Sahai-Srivastava, MD University of Southern California Department of Neurology, Los Angeles, California, USA 1. Background 3. Results 4. Chemicals in Electronic Cigarettes E-cigarette use is increasing in popularity Types and amounts of chemicals in e-cigarettes vary widely Nicotine and other chemicals in e-cigarettes are known to cause headaches NDPH IHS Guidelines Distinctly remembered Persistent headache Daily from the onset Continuous, unremitting within 24 hours Present for >3 months No case reports of NDPH in an adolescent after e-cigarette use per literature review 13 year-old girl with no significant past medical history smoked an e-cigarette on one occasion after which she developed a headache. The type of e-cigarette smoked did not contain nicotine. The headache began immediately after smoking the e-cigarette and had been constant for 5 months. Headaches were throbbing, pulsating, and sharp, located on the occiput and vertex. Severity ranged from 7/10-10/10. Photophobia, phonophobia, and difficulty concentrating were also present. Stress, missed meals, sleeping too little, and menses were triggers. Rest, darkness, and quiet decreased the severity of her headaches. As a result of her headaches she had difficulty sleeping, and was on a modified school program. She had no history of bullying and denied depression. pedMIDAS was >50 indicating severe disabilty due to her headaches. Physical examination :The neurologic exam and MRI brain were unremarkable. She had an eye exam and dental exam, which were normal. Treatment : Previously failed: propranolol, ibuprofen, naproxen, Excedrin®, hydrocodone, nortriptyline, frovatriptan, and sumatriptan. She was treated in the infusion center with IV magnesium sulfate with no improvement. This was followed by IV ketorolac, dexamethasone, and IV metoclopramide, still with no improvement. A sphenopalatine ganglion block using the Tx360® nasal applicator with 0.3 ml 0.5% bupivacaine bilaterally was performed. At the end of the infusion center visit, she still felt no improvement. However, at 2 month follow up, she had returned to a regular school schedule, and reported a 50% reduction in severity of her daily headache since the infusion center visit. Nicotine Aldehydes, eg. formaldehyde Drugs, eg. amino-tadalafil Tobacco alkaloids, eg. cotinine Metals, eg. nickel Volatile organic compounds, eg. toluene Flavors Solvents, eg. glycerol Phenolic compounds, eg. hydroquinone Polycyclic aromatic hydrocarbons, e.g. anthracene Copy and paste your text content here, adjusting the font size to fit 5. Conclusions Our case describes new daily persistent headache which developed in an adolescent girl after one time usage of an e-cigarette, which did not containing nicotine. Many chemicals are inhaled when using e-cigarettes, some of which can cause headaches. Practitioners should screen patients with headaches about e-cigarette use due to their potential to cause headaches. 2. Methods 5. References This is a case report and review of literature. 1. Pubmed search: electronic cigarette, e-cigarette, headache, adolescent, pediatric 2. Google scholar search: electronic cigarette, e-cigarette, headache, adolescent, pediatric 3. Wikipedia.com 4. http:/www./ecigarettes365.com 5. Effects of electronic cigarette smoking on human health. Eur Rev Med Pharmacol Sci. 2014;18(21):3315-9 6. E-cigarettes generate high levels of aldehydes only in ‘dry-puff’conditions.Addiction.20 May 2015. 7. E-cigatette smoke found to contain toxic mettals, USC news. August 28, 2014. 8. Comparison of Select Analytes in Exhaled Aerosol from E-Cigarettes with Exhaled Smoke from a Conventional Cigarette and Exhaled Breaths. Long, G. Int. J. Environ. Res. Public Health 2014, 11, 11177-11191 9. Nickel risk in metal processing workers. Highlights on toxic and allergic effectsICirla, et al. G Ital Med Lav Ergon. 2011 Jul-Sep;33(3 Suppl):53-6

E-cigarettes generate high levels of aldehydes only in ‘dry puff’ conditions IV magnesium sulfate with no improvement. This was followed by IV ketorolac 15mg, IV dexamethasone 2mg, and IV metoclopramide 5mg followed by SPG block using Tx360® nasal applicator with 0.3 ml 0.5% bupivacaine bilaterally. Headache severity was reduced by 50% at 2 months Eur Rev Med Pharmacol Sci. 2014;18(21):3315-9.

www.wikipedia.com Pubmed search: electronic cigarette, e-cigarette, headache, adolescent, pediatric Google scholar search:electronic cigarette, e-cigarette, headache, adolescent, pediatric http://www.ecigarettes365.com/images/e-cigarette-brands.png www.wikipedia.com http://www.ecigarettes365.com/images/e-cigarette-brands.png www.wikipedia.com Pubmed search: electronic cigarette, e-cigarette, headache, adolescent, pediatric Google scholar search:electronic cigarette, e-cigarette, headache, adolescent, pediatric