Just thought I would post some information I received from my doctor who has been treating me for daily persistent headaches. I have been telling him for over a year that I believe there is some common underlying element to both my headaches and Rosacea because when my Rosacea flares so do my headches (or vice versa). I had done some research and found one study that commented on the prevelance of chronic migraine sufferers in Rosacea patients. Now, it appears, for those with Rosacea and chronic headaches, there may be a link, our good friend cytokines:
Doxycycline for Treatment Resistant New Daily Persistent
Headache
Rozen T.D.
Neurology, MHNI, Ann Arbor, MI, USA
Objectives:
•To test the efficacy of doxycycline, a tumor
necrosis factor (TNF) α inhibitor, in patients with treatment
resistant NDPH with elevated CSF TNF α levels.
Background:
•NDPH is one of the most treatment resistant
of all the primary headache disorders. A significant number of
NDPH patients start having their headaches after an infection, so
proinflammatory cytokines may play a role in the pathogenesis of
NDPH. Rozen and Swidan recently demonstrated an elevation of
CSF TNF α levels in 19 of 20 NDPH patients. They hypothesized
that NDPH was caused by glial cell activation leading to a release
of TNF α into the CSF resulting in CNS inflammation and
persistent daily headache. Doxycycline is a tetracycline derivative
that along with its bacteriostatic capabilities has anti-inflammatory
properties. Doxycycline can suppress TNF α production and
inhibit microglial activation. It has good penetration into the
brain and CSF. The mechanism of action of doxycycline makes
it a good preventive candidate for NDPH.
Methods:
Four patients with treatment resistant NDPH and
elevated CSF TNF α levels (>8.2pg/ml) were treated with
doxycycline 100mg PO BID in an open label fashion for 3 months.
Headache frequency and pain intensity levels were assessed. (Pain
scale levels were 0-5; 0: no pain, 1-2: mild pain, 3: moderate pain,
4-5: severe pain). All patients had failed at least five preventive
agents and thus were deemed treatment refractory. 3 of 4 patients
failed inpatient headache treatment while another failed outpatient
infusion therapy. Age of onset of NDPH ranged from 13-39
years. Duration of NDPH prior to doxycycline therapy ranged
from 8 months to 3 years. An infection precipitated NDPH in 3
of 4 patients.
Results:
All patients had a positive response to treatment. Two
patients became pain free. One patient had an 80% improvement
in daily pain intensity, but did not acheive any pain-free time. One
patient had a slight improvement in daily pain intensity, but had
a > 50% reduction in frequency of severe pain episodes. Average
time to improvement on doxycycline was 2 months, although
one patient responded within 2 weeks. Doxycycline was welltolerated
overall, but one patient developed a severe sunburn on
the medication.
Conclusions:
This small open label investigation suggests
that doxycycline may have efficacy in treatment resistant NDPH
patients who have elevated CSF TNF α levels. Doxycycline
appears to reduce headache frequency and/or headache intensity.
Time to onset of action is about 2 months, thus a 3 month treatment
trial is suggested for all patients. Further study of doxycycline in
NDPH is suggested.
I was actually stunned when I read this article because my Rosacea and headaches both started shortly after I finished the worst throat infection I had ever had in my life. It tested negative for strep and was diagnosed as viral. It took 2 months to fight it off completely (and I was in agonizing pain for 3 weeks, lost my voice for 2 of them).
Could it be that Rosacea, NDPH and other disroders like Rhuematoid are triggered by a breakdown in the immune system response to a virus? Is it as simple in theory as the body simply not knowing to stop producing a certain proinflammatory cytokine originally intended to fight off that virus?
It bears noting on the treatment front that biologics have been used very successfully in the last few years to suppress cytokines production in other inflammatory diseases, normally resulting in significant improvement if not outright remission.
Query: Where is our mother#$%#$% biologics for Rosacea 
Cytokines and Inflammation
Reply With Quote
