Features and Management of New Daily Persistent Headache in Developmental-Age Patients

Abstract

Introduction. Our aim was to investigate the clinical features of primary new daily persistent headache (NDPH) in a cohort of paediatric patients. Methods. We reviewed the data of patients with persistent daily headache, attending the Headache Centre of Bambino Gesù Children from the January 2009. The ICHD-III criteria were used for diagnosis. Statistical analysis was conducted to study possible correlations between NDPH and population features (age and sex), NDPH and headache qualitative features, and NDPH and response to pharmacological therapies. Results. We included 46 subjects with NDPH. The features of pain more closely resembled those of migraine than to those of tension-type headache (62 vs. 38%). The NDPH patients showed nausea and vomiting less frequently than migraine ones (28.6 vs. 48.2%, p < 0.01). A total of 75% of NDPH patients experienced an onset of the symptoms in the winter months (November to February) (p < 0.01). NDPH was less common in very young children under 10 years of age. Almost 58% of NDPH patients received pharmacological therapy and the most used drug was amitriptyline. A reduction of attacks by at least 50% in a month was detected in 30.6% of patients. Conclusions. NDPH can be very disabling and correlates with seasonal factors. Although long term pharmacological therapy is recommended, considering the long duration that this headache can have, there are no data supporting the treatment choice.

Update of New Daily Persistent Headache

“…Surprisingly, up to 80% of patients had an initially good clinical response to common migraine prophylactic treatment in the first year, but at follow-up one year later, 54% of them returned to a remitting form of headache. Two unfavorable outcome predictors were identified, including the lack of obvious trigger and no pharmacological treatment [ 24 ], the latter of which echoes the earlier study that patients with early (within 6 months) pharmacological treatment after the onset of NDPH were more likely to have a favorable outcome [ 5 ]. NDPH may be easier to treat before the chronification has been well-established.…”

“…A recent study in Italy looked into 46 pediatric patients with NDPH following ICHD-3 criteria [ 24 ]. The headache features are mostly migrainous (62%), and 75% of them had an onset in the winter months.…”

Probable New Daily Persistent Headache After COVID-19 in Children and Adolescents

“…Within the pediatric population, NDPH occurs more frequently in females, and its start may correlate with stress from school or infection 6 . These headaches have classically been challenging to treat.…”

Neu aufgetretener täglicher Kopfschmerz

“…Einige Studien zeigten, dass das Erstmanifestationsalter bei Frauen jünger ist als bei Männern [22,23]. Eine Studie beobachtete eine signifikant häufigere Erstmanifestation in den Wintermonaten verglichen zu den Sommermonaten [24]. Eine familiäre Häufung des NDPH ist nicht berichtet worden, Kopfschmerzerkrankungen in der Familiengeschichte wurden in einigen Studien mit unterschiedlichen Kriterien berichtet, die Raten lagen dabei zwischen 27 % [20] und 49 % [21].…”

“…Amitriptylin und ähnliche Substanzen werden beim NDPH sehr häufig eingesetzt, ohne dass dies in Studien evaluiert worden ist. Bei Kindern und Jugendlichen mit NDPH wurde eine Reduzierung der Kopfschmerzen um > 50 % bei 30,6 % der Betroffenen durch Amitriptylin beobachtet [24]. Eine Feldstudie aus den USA über Verschreibungen bei chronischen Kopfschmerzen bei Kindern und Jugendlichen ergab, dass beim NDPH Amitriptylin und danach Topiramat am häufigsten verschrieben wurden [56].…”