Many with NDPH noted a flu-like illness, or a virus, shortly before the sudden onset of the headache; however, even though EBV(the mono virus) is found in most with NDPH, the association with a virus is murky at best. Stress, after surgery, toxic exposures, these are all possible triggering events.Todd Rozen,M.D., neurologist/headache specialist, has noted that cervical spine joint hypermobility may play a role. In those with frequent headaches, connective tissue disorders that lead to joint hypermobility may predispose to the headaches. NPH patients are somewhat more likely to have thin, long necks, and be tall and thin themselves. The other factor noted by Dr. Rozen(in Headache Currents, in Headache, Aprill 2011) is CNS inflammation, with an elevation(increase) in Tumor necrosis factor alpha(TNF alpha). This goes along with previous studies indicating an overactive central immune system in headache patients, with “pro-inflammatory” proteins floating around the brain and head. I began publishing on this in the late 1980’s, as I was convinced, and still am, that the immune system plays a key role in headache. We will get into treatment of NDPH later, although it is often a difficult condition to treat.