After purchasing a new car in 2002, a man in good health who previously had no history of headaches began experiencing bouts of severe, persistent headaches—a condition that still baffles doctors after nearly 20 years, Sandra Boodman writes for the Washington Post.

Expedite patient diagnosis

The patient's long history of unexplained symptoms—and unanswered questions

In 2002, Tom Wells was in good overall health and had no history of headaches—but that all changed when he bought a new car. Within hours of driving his new car off the lot, Wells developed a strange headache and experienced a burning in the middle of his head that he said felt like "someone was sandpapering [his] brain."

Notably, Wells did not experience the same issues when driving his wife Susan's older car. He believed an exhaust leak in his new car may have been the source of his problems, so he returned it and purchased a used vehicle—but the same thing occurred when he drove the used car.

Searching for answers, Wells consulted an allergist and was referred to an environmental health specialist at Johns Hopkins Hospital (JHU).

The specialist told Wells he suspected he was highly sensitive to volatile organic compounds (VOC), which are gasses emitted into the air that are found in an array of products and processes, Boodman writes. Notably, VOCs are used in the vehicle manufacturing process and are responsible for the "new car smell."

As a precautionary measure, Wells' physician advised him to steer clear of triggers such as fresh paint, new cars, and new carpet. He followed this advice and remained headache-free for several years—until the couple bought new furniture in 2008. Even after they returned the furniture, his headache lingered for several weeks.

Concerned by the longer duration of his headaches, Wells was ultimately referred to his now long-time neurologist, Nirjal Nikhar, who suspected Wells' headaches had an "inflammatory component" to them. Nikhar prescribed increasingly large doses of prednisone.

Initially, Wells said he couldn't tell whether the drug was working. But when he parked his car in a newly painted garage, he had a headache within 30 minutes that persisted for two months, despite the high doses of prednisone.

Then, in 2015, when Wells and Susan went to see a movie in a recently renovated theater, they immediately noticed the smell of new carpet and paint. After spending three hours in the movie theater, Wells developed a headache that lasted six years.

A 2016 MRI of Wells' brain showed several deep white matter lesions. While these lesions can be caused by migraines, multiple sclerosis, and other ailments, the cause of his lesions was unknown.

"No one can say what they mean," said Nikhar, highlighting the fact that they are not typical for a man in his 50s. Since then, Wells has had several MRIs that show no change.

Over the next three years, Wells explored a variety of treatments—but nothing seemed to offer any relief.

In 2019, Nikhar prescribed a benzodiazepine—a sedative that is typically used to treat anxiety, insomnia and panic disorder—to treat Wells. Surprisingly, his pain started to dissipate. "How it helps his headaches is not clear," Nikhar said. "Maybe calming him down relaxes his muscles."

Nikhar said he does not believe Wells' headaches stem from anxiety. "I think the anxiety is there as a result of the symptoms," he said. "I don't think the anxiety is a driver of his headaches."

However, Wells' headaches returned with increased intensity by the end of 2019.

Finding relief with a 'somewhat out of the box' treatment

In 2020, Nikhar encouraged Wells to make an appointment with a neurologist at Cleveland Clinic who specialized in headache treatments. Right before his appointment with the Cleveland Clinic neurologist, Nikhar prescribed Wells a second medication—an antidepressant approved for the treatment of nerve pain that is sometimes used to treat migraines.

The Cleveland Clinic doctor suggested that Wells could be experiencing central sensitization, a phenomenon in which the central nervous system amplifies pain signals sent to the brain, Boodman writes.

While the cause of this condition is unknown, genetic factors such as a heightened response to pain or a precipitating event such as trauma or surgery can trigger central sensitization, Boodman writes. The doctor recommended Wells continue to take the antidepressant to gauge its effectiveness.

Just four months later, Wells' headaches had improved significantly. He continues to take the antidepressant and the benzodiazepine during pain flares.

Although Nikhar said he has no clue why this "somewhat out of the box" combination of drugs works for Wells, he noted that central sensitization is "well-recognized in headaches." He added, "In neurology, there's no end of unanswered questions."

So far, Wells said his headaches have remained "very manageable. [He's] trying to take as little medication as [he] can." Eventually, Wells said he hopes to stop taking both medications altogether. (Boodman, Washington Post, 9/25)