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Kalika P, Monteith TS. New Daily Persistent Headache in the Pediatric and Adolescent Population: An Updated Review. Life (Basel) 2024; 14:724. [PMID: 38929707 PMCID: PMC11204919 DOI: 10.3390/life14060724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE OF REVIEW New daily persistent headache (NDPH) is a primary headache disorder characterized by the sudden onset of continuous pain and its intractability to treatment. It is more prevalent in the pediatric population than the adult population, but remains understudied and underdiagnosed. The purpose of the current article is to provide a current overview of new daily persistent headache in the pediatric and adolescent population, including history, pathophysiology, clinical findings, current and emerging treatment options, and the results of recent studies and meta-analyses. RECENT FINDINGS Despite recent studies and meta-analyses showing significant phenotypic overlap between chronic migraine and NDPH in the pediatric population, multiple recent studies have come to conflicting conclusions about the overlap of medication overuse in headache and pediatric NDPH. Recent studies reveal alterations in neuroimaging, particularly in functional connectivity, in patients with NDPH. Patients frequently remain treatment-refractory even to medications that have historically proven helpful in this population; however, new treatment options, including calcitonin gene-related peptide (CGRP) monoclonal antibodies, may be more effective. SUMMARY NPDH remains a perplexing and difficult-to-manage condition for both children and adults. Despite a higher prevalence in the pediatric population, there are relatively few studies to guide the evaluation and treatment of NDPH in pediatric and adolescent patients. Early treatment, both pharmacological and non-pharmacological, should be employed to reduce disability. Overall, further studies are needed to better understand pathogenesis and to identify more effective therapeutic strategies, both pharmacological and non-pharmacological.
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Affiliation(s)
- Paige Kalika
- Division of Pediatric Neurology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Teshamae S. Monteith
- Division of Headache Medicine, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Robbins M. New Daily Persistent Headache. Continuum (Minneap Minn) 2024; 30:425-437. [PMID: 38568492 DOI: 10.1212/con.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article describes the clinical features, etiology, differential diagnosis, management, and prognosis of new daily persistent headache. LATEST DEVELOPMENTS New daily persistent headache has attracted renewed attention as it may arise in the setting of a COVID-19 infection. Spontaneous intracranial hypotension, particularly from CSF-venous fistulas, remains an important secondary headache disorder to consider before diagnosing new daily persistent headache. Symptomatic treatment for new daily persistent headache may include acute and preventive therapies used for migraine and tension-type headache, such as triptans, oral preventive agents, onabotulinumtoxinA, and agents that target calcitonin gene-related peptide. ESSENTIAL POINTS New daily persistent headache is a daily headache syndrome that starts acutely and can only be diagnosed after 3 months have elapsed and other secondary and primary headache diagnoses have been excluded. The clinical manifestations largely resemble either chronic migraine or chronic tension-type headache. The underlying cause is unknown, but it is plausible that multiple etiologies exist and that it is not a single disease entity. The prognosis is variable but often poor, and the treatment approach is largely extrapolated from the management of chronic migraine and chronic tension-type headache.
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Gibler RC, Knestrick KE, Powers SW, Hershey AD, Kabbouche M, Kacperski J, Reidy BL. Preliminary prospective observational investigation of clinical outcomes among treatment-seeking youth with continuous headache. Headache 2024; 64:319-322. [PMID: 38504449 DOI: 10.1111/head.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Robert C Gibler
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kaelynn E Knestrick
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew D Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Marielle Kabbouche
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joanne Kacperski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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4
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Carrión-Nessi FS, Ascanio LC, Pineda-Arapé AG, Omaña-Ávila ÓD, Mendoza-Millán DL, Romero SR, Almao-Rivero AB, Camejo-Ávila NA, Gebran-Chedid KJ, Rodriguez-Saavedra CM, Freitas-De Nobrega DC, Castañeda SA, Forero-Peña JL, Delgado-Noguera LA, Meneses-Ramírez LK, Cotuá JC, Rodriguez-Morales AJ, Forero-Peña DA, Paniz-Mondolfi AE. New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study. BMC Infect Dis 2023; 23:877. [PMID: 38097988 PMCID: PMC10722794 DOI: 10.1186/s12879-023-08898-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes. METHODS We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student's t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson's chi-square and Fisher's exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH. RESULTS Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH. CONCLUSION This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Luis C Ascanio
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Andreína G Pineda-Arapé
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Óscar D Omaña-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniela L Mendoza-Millán
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Sinibaldo R Romero
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Medical Scientist Training Program (MD/PhD), University of Minnesota Medical School, Minneapolis, MN, USA
| | - Abranny B Almao-Rivero
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Natasha A Camejo-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | | | | | - Diana C Freitas-De Nobrega
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Sergio A Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología, Facultad de Ciencias Naturales, Universidad del Rosario (CIMBIUR), Universidad del Rosario, Bogotá, Colombia
| | - José L Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Lourdes A Delgado-Noguera
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Lucianny K Meneses-Ramírez
- "Dr. Francisco Battistini Casalta" Health Sciences School, University of Oriente - Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Juan C Cotuá
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Alfonso J Rodriguez-Morales
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - David A Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela.
| | - Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Cheema S, Stubberud A, Rantell K, Nachev P, Tronvik E, Matharu M. Phenotype of new daily persistent headache: subtypes and comparison to transformed chronic daily headache. J Headache Pain 2023; 24:109. [PMID: 37587430 PMCID: PMC10428606 DOI: 10.1186/s10194-023-01639-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is unknown whether new daily persistent headache (NDPH) is a single disorder or heterogenous group of disorders, and whether it is a unique disorder from chronic migraine and chronic tension-type headache. We describe a large group of patients with primary NDPH, compare its phenotype to transformed chronic daily headache (T-CDH), and use cluster analysis to reveal potential sub-phenotypes in the NDPH group. METHODS We performed a case-control study using prospectively collected clinical data in patients with primary NDPH and T-CDH (encompassing chronic migraine and chronic tension-type headache). We used logistic regression with propensity score matching to compare demographics, phenotype, comorbidities, and treatment responses between NDPH and T-CDH. We used K-means cluster analysis with Gower distance to identify sub-clusters in the NDPH group based on a combination of demographics, phenotype, and comorbidities. RESULTS We identified 366 patients with NDPH and 696 with T-CDH who met inclusion criteria. Patients with NDPH were less likely to be female (62.6% vs. 73.3%, p < 0.001). Nausea, vomiting, photophobia, phonophobia, motion sensitivity, vertigo, and cranial autonomic symptoms were all significantly less frequent in NDPH than T-CDH (p value for all < 0.001). Acute treatments appeared less effective in NDPH than T-CDH, and medication overuse was less common (16% vs. 42%, p < 0.001). Response to most classes of oral preventive treatments was poor in both groups. The most effective treatment in NDPH was doselupin in 45.7% patients (95% CI 34.8-56.5%). Cluster analysis identified three subgroups of NDPH. Cluster 1 was older, had a high proportion of male patients, and less severe headaches. Cluster 2 was predominantly female, had severe headaches, and few associated symptoms. Cluster 3 was predominantly female with a high prevalence of migrainous symptoms and headache triggers. CONCLUSIONS Whilst there is overlap in the phenotype of NDPH and T-CDH, the differences in migrainous, cranial autonomic symptoms, and vulnerability to medication overuse suggest that they are not the same disorder. NDPH may be fractionated into three sub-phenotypes, which require further investigation.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Anker Stubberud
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Khadija Rantell
- Education Unit, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Parashkev Nachev
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Yang Y, Cao Y. Rising trends in the burden of migraine and tension-type headache among adolescents and young adults globally, 1990 to 2019. J Headache Pain 2023; 24:94. [PMID: 37495946 PMCID: PMC10373384 DOI: 10.1186/s10194-023-01634-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Headache disorders are major contributors to disability in adolescents and young adults worldwide. We aimed to analyze global trends in the burden of migraine and tension-type headache in 10 to 24-year-olds from 1990 to 2019. METHODS Data were obtained from the Global Burden of Disease Study (GBD) 2019 to examine trends in incidence, prevalence, and disability-adjusted life years (DALYs) for migraine and tension-type headache in adolescents and young adults by location, age, sex and sociodemographic index (SDI). Joinpoint regression analyzed trends and identified years of significant change. RESULTS Globally, migraine and tension-type headache incidence, prevalence, and DALYs increased from 1990 to 2019, though with some fluctuations. The highest growth in migraine incidence occurred in males and individuals aged 10-14, while for tension-type headache incidence, it was observed in males and individuals aged 20-24. Prevalence and DALYs were highest for both disorders in females and those aged 20-24 years. Incidence increased fastest in East Asia for migraine and tension-type headache. For migraine, Tropical Latin America had the fastest increase in prevalence and DALYs. East Asia had the fastest increase in prevalence of tension-type headache, while North Africa and the Middle East had the highest growth in DALYs. Some high-income countries such as Singapore, Norway, and Iran (Islamic Republic of) demonstrated fast increases, while a few countries including Qatar, Thailand and Ethiopia decreased. CONCLUSIONS The incidence, prevalence and disability from migraine and tension-type headache are rising in adolescents and young adults, especially in males, older youth and middle SDI populations. The increasing trends highlight the need for targeted interventions focused on prevention and control in priority populations. Continued monitoring of trends can help identify strategies to promote headache health and reduce the life-course impacts of headache disorders globally.
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Affiliation(s)
- Ying Yang
- Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Yu Cao
- Xiang'an Hospital of Xiamen University, Xiamen, China.
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Gibler R, Peugh J, Coffey C, Ann Chamberlin L, Ecklund D, Klingner E, Yankey J, Korbee L, Kabbouche M, Kacperski J, Porter L, Reidy B, Hershey A, Powers S. Impact of preventive pill-based treatment on migraine days: A secondary outcome study of the Childhood and Adolescent Migraine Prevention (CHAMP) trial and a comparison of self-report to nosology-derived assessments. Headache 2023; 63:805-812. [PMID: 36757131 PMCID: PMC10293029 DOI: 10.1111/head.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To examine group differences in self-reported migraine days among youth who completed the Childhood and Adolescent Migraine Prevention (CHAMP) trial prior to its closure and explore the relationship between self-reported and "nosology-derived" (i.e., International Classification of Headache Disorders, 3rd edition [ICHD-3]) migraine days. BACKGROUND The CHAMP trial compared amitriptyline and topiramate to placebo for migraine prevention in youth and proposed to analyze change in migraine days as a secondary outcome. There is considerable variability in the field regarding what constitutes a "migraine day," how this is determined and reported in trials, and how consistent these measures are with diagnostic nosology. METHODS CHAMP trial completers (N = 175) were randomized to receive amitriptyline (n = 77), topiramate (n = 63), or placebo (n = 35). Participants maintained daily headache diaries where they reported each day with headache and if they considered that headache to be a migraine. For each headache day, participants completed a symptom record and reported about symptoms such as pain location(s) and presence of nausea/vomiting or photophobia and phonophobia. We examined group differences in self-reported migraine days at trial completion (summed from trial weeks 20-24) compared to baseline. We also used an algorithm to determine whether participants' symptom reports met ICHD-3 criteria for migraine without aura, and examined the association between self-reported and "nosology-derived" migraine days. RESULTS Results showed no significant differences between groups in self-reported migraine days over the course of the trial. Self-reported and "nosology-derived" migraine days during the baseline and treatment phases were strongly associated (r's = 0.73 and 0.83, respectively; p's < 0.001). CONCLUSION Regardless of treatment, CHAMP trial completers showed clinically important reductions in self-reported migraine days over the course of the trial (about 3.8 days less). The strong association between self-reported and "nosology-derived" migraine days suggests youth with migraine can recognize a day with migraine and reliably report their headache features and symptoms. Greater rigor and transparency in the calculation and reporting of migraine days in trials is needed.
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Affiliation(s)
- Robert Gibler
- Cincinnati Children’s Hospital Medical Center - Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - James Peugh
- Cincinnati Children’s Hospital Medical Center - Pediatrics, Cincinnati, Ohio, USA
| | | | - Leigh Ann Chamberlin
- Cincinnati Children’s Hospital Medical Center - Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Dixie Ecklund
- University of Iowa – Biostatistics, Iowa City, Iowa, United States
| | | | - Jon Yankey
- University of Iowa – Biostatistics, Iowa City, Iowa, United States
| | - Leslie Korbee
- Academic Regulatory & Monitoring Services, LLC - Academic Regulatory & Monitoring Services, LLC., Cincinnati, Ohio, United States
| | - Marielle Kabbouche
- Cincinnati Children’s Hospital Medical Center - Child Neurology, Cincinnati, Ohio, USA
| | - Joanne Kacperski
- Cincinnati Children’s Hospital Medical Center - Neurology, Cincinnati, Ohio, USA
| | - Linda Porter
- National Institute of Health, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, United States
| | - Brooke Reidy
- Cincinnati Children’s Hospital Medical Center - Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Andrew Hershey
- Cincinnati Children’s Hospital Medical Center - Neurology, Cincinnati, Ohio, USA
| | - Scott Powers
- Cincinnati Children’s Hospital Medical Center - Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
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Abstract
Background Accumulating evidence suggests various specific triggers may lead to new daily persistent headache (NDPH)-like presentations, suggesting that new daily persistent headache is a heterogenous syndrome, and challenging the concept that new daily persistent headache is a primary headache disorder.Method We searched the PubMed database up to August 2022 for keywords including persistent daily headache with both primary and secondary etiologies. We summarized the literature and provided a narrative review of the clinical presentation, diagnostic work-ups, possible pathophysiology, treatment response, and clinical outcomes.Results and conclusion New daily persistent headache is a controversial but clinically important topic. New daily persistent headache is likely not a single entity but a syndrome with different etiologies. The issue with past studies of new daily persistent headache is that patients with different etiologies/subtypes were pooled together. Different studies may investigate distinct subsets of patients, which renders the inter-study comparison, both positive and negative results, difficult. The identification (and removal) of a specific trigger might provide the opportunity for clinical improvement in certain patients, even when the disease has lasted for months or years. Nonetheless, if there is a specific trigger, it remains unknown or unidentified for a great proportion of the patients. We need to continue to study this unique headache population to better understand underlying pathogenesis and, most importantly, to establish effective treatment strategies that hopefully resolve the continuous cycle of pain.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Todd D Rozen
- Department of Neurology, Mayo Clinic, Florida, USA
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Patterson Gentile C, Aguirre GK, Hershey AD, Szperka CL. Comparison of continuous headache features in youth with migraine, new daily persistent headache, and persistent post-traumatic headache. Cephalalgia 2023; 43:3331024221131331. [PMID: 36587297 PMCID: PMC10029693 DOI: 10.1177/03331024221131331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare clinical features in youth with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache to determine if they are similar, contrary to their distinction in the International Classification of Headache Disorders. METHODS We pursued a single center age- and sex-matched observational study comparing the clinical characteristics of 150 youth (11 - 17 years old) with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache. A diagnostic algorithm based on international classification of headache disorders criteria was used to identify those with migraine (headache features of migraine with gradual onset), and persistent post-traumatic headache and new daily persistent headache (based on the circumstances of headache onset regardless of headache features). Fifty participants each with migraine, persistent post-traumatic headache, and new daily persistent headache were matched by age and sex. Participant survey responses on headache characteristics were compared. RESULTS Median usual headache severity was 6.0 [95%CI 6.0, 6.0] and was not different across diagnostic groups (H statistic = 1.2, p = 0.55). Headache exacerbation frequency, disability, associated symptoms, and most triggers were not significantly different across groups. The majority of persistent post-traumatic headache and new daily persistent headache had headache features consistent with a diagnose of migraine (72% and 62%, respectively). CONCLUSION Our findings suggest that most persistent post-traumatic headache and new daily persistent headache may represent abrupt onset of migraine.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Geoffrey K Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Christina L Szperka
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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10
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Begasse de Dhaem O, Rizzoli P. Refractory Headaches. Semin Neurol 2022; 42:512-522. [DOI: 10.1055/s-0042-1757925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractMedication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.
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Affiliation(s)
- Olivia Begasse de Dhaem
- Headache Specialist at Hartford HealthCare, Hartford, Connecticut
- Department of Neurology at the University of Connecticut, Milford, Connecticut
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Faulkner Hospital J Graham Headache Center, Boston, Massachusetts
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11
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Nagaraj K, Wei DY, Puledda F, Weng H, Waheed S, Vandenbussche N, Ong JJY, Goadsby PJ. Comparison and predictors of chronic migraine vs. new daily persistent headache presenting with a chronic migraine phenotype. Headache 2022; 62:828-838. [PMID: 35861031 PMCID: PMC9545870 DOI: 10.1111/head.14362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Objective To compare the clinical phenotype of patients with chronic migraine (CM) to patients with new daily persistent headache of the chronic migraine subtype (NDPH‐CM). Methods A study was conducted of CM (n = 257) and NDPH‐CM (n = 76) from a tertiary headache center in the UK, and in the US of patients with daily CM (n = 60) and NDPH‐CM (n = 22). Results From the UK cohort, the age of first headache onset was lower in CM (mean ± SD: 16 ± 12 years) than in NDPH‐CM (mean ± SD: 23 ± 14 years; p < 0.001). There was a greater number of associated migrainous symptoms in CM compared to NDPH‐CM (median and interquartile range: 6, 5–8 vs. 5, 4–7; p < 0.001). A family history of headache was more common in CM compared to NDPH‐CM (82%, 202/248, vs. 53%, 31/59; p < 0.001). In the US cohort there were no differences. Osmophobia (B = −1.08; p = 0.002) and older age at presentation to the clinic (B = −0.06; p = 0.001) were negative predictors of NDPH‐CM. Conclusion NDPH‐CM is relatively less migrainous than CM in the UK cohort. Family history of headache is less common in NDPH‐CM, with negative predictors for NDPH‐CM including osmophobia and older age of presentation to the clinic. More work is required to understand the chronic migraine phenotype of new daily persistent headache.
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Affiliation(s)
- Karthik Nagaraj
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Department of Neurology Bangalore Medical College and Research Institute Bangalore India
| | - Diana Y. Wei
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
| | - Francesca Puledda
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
| | - Hsing‐Yu Weng
- Department of Neurology Taipei Municipal Wanfang Hospital Taipei Taiwan
- Department of Neurology, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Sadaf Waheed
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Nicolas Vandenbussche
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Department of Neurology Ghent University Hospital Ghent Belgium
| | - Jonathan J. Y. Ong
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Division of Neurology, Department of Medicine National University Hospital, National University Health System Singapore Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Peter J. Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
- Department of Neurology University of California Los Angeles California USA
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12
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Szabo E, Chang YC, Shulman J, Sieberg CB, Sethna NF, Borsook D, Holmes SA, Lebel AA. Alterations in the structure and function of the brain in adolescents with new daily persistent headache: A pilot
MRI
study. Headache 2022; 62:858-869. [DOI: 10.1111/head.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Edina Szabo
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Julie Shulman
- Department of Physical Therapy and Occupational Therapy Boston Children's Hospital Boston Massachusetts USA
| | - Christine B. Sieberg
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
| | - Navil F. Sethna
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
| | - David Borsook
- Department of Psychiatry Massachusetts General Hospital Boston Massachusetts USA
- Department of Radiology Massachusetts General Hospital Boston Massachusetts USA
- Department of Anesthesiology Harvard Medical School Boston Massachusetts USA
| | - Scott A. Holmes
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Pediatric Pain Pathway Lab, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | - Alyssa A. Lebel
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
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13
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Morris C, Ross A, Greene K, Irwin S, Wagstaff A, Gelfand A. Outcomes That Matter to Adolescents With Continuous Headache Due to Chronic Migraine and Their Parents: A Pilot Survey Study. Neurology 2022; 98:e2347-e2355. [PMID: 35418460 DOI: 10.1212/wnl.0000000000200292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Children and adolescents with chronic migraine who have continuous headache may have high levels of headache-related disability but have largely been excluded from clinical trials. Understanding patient-valued treatment outcomes may facilitate future study design. OBJECTIVE To identify patient-valued outcome measures for headache preventive treatments among adolescents with continuous headache due to chronic migraine and their parents. METHODS Adolescents with an ICHD-3 diagnosis of chronic migraine, who had continuous headache and who were being cared for at a tertiary pediatric headache clinic, and their parents, were surveyed to query the value of treatment outcomes in the domains of headache frequency, intensity, functional impact, and associated symptoms. Individual outcomes and categories of outcomes were ranked in order of preference using weighted average rank. Results were rounded to the degree of precision with which they were measured. RESULTS The survey was completed by 55 adolescents and 60 parents of adolescents with continuous headache due to chronic migraine. Mean age of adolescents was 16 (SD 1, range 12 to 17). Median adolescent-reported duration of continuous headache was 24 months (IQR 12-39) and adolescents had tried a median (IQR) of 2 (0-5) preventive medications, only 13% of which were perceived as helpful. Overall, the most valued individual outcome measure among both adolescents and parents was a decrease in frequency of more severe headaches; however, outcomes reflecting headache intensity were most valued by adolescents while outcomes reflecting functional impact were most valued by parents. Over 60% of adolescents felt that it was more important to measure decrease in frequency and intensity of headaches in terms of severe headaches/spikes rather than total headache days. Among associated symptoms, improvement in "brain fog" was most highly valued by both adolescents and parents. DISCUSSION The results of this study provide important information about which preventive treatment outcomes are valued by adolescents with continuous headache due to chronic migraine and their parents. Results suggest that adolescents value a decrease in frequency of severe headaches over a decrease in frequency of headache days overall. Generalizability may be limited as the surveyed population were being cared for at a tertiary pediatric headache clinic and generally had headache disorders that were refractory to treatment. These results may help guide future trial design in this population with continuous headache due to chronic migraine. TRIAL REGISTRATION NA.
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Affiliation(s)
- Cynthia Morris
- Division of Child Neurology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | - Alexandra Ross
- Child & Adolescent Headache Program, University of California, San Francisco, UCSF Benioff Children's Hospital
| | - Kaitlin Greene
- Doernbecher Children's Hospital Child and Adolescent Headache Program, Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Samantha Irwin
- Child & Adolescent Headache Program, University of California, San Francisco, UCSF Benioff Children's Hospital
| | - Amanda Wagstaff
- Child & Adolescent Headache Program, University of California, San Francisco, UCSF Benioff Children's Hospital
| | - Amy Gelfand
- Child & Adolescent Headache Program, University of California, San Francisco, UCSF Benioff Children's Hospital
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14
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Abu-Arafeh I. Predicting quality of life outcomes in children with migraine. Expert Rev Neurother 2022; 22:291-299. [PMID: 35263201 DOI: 10.1080/14737175.2022.2051481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Several studies have shown that the response of children with migraine to medications is suboptimum and inferior to the response reported in adults, despite the similar pathogenesis and biological mechanisms. The poor response may be related to the significant differences that make assessment and treatment of children with migraine more challenging than in adults. AREAS COVERED The purpose of this review is to discuss the whole process of assessment of children with migraine, the necessary skills for eliciting the clinical features, making the correct diagnosis and exploring lifestyle issues, co-morbid conditions (psychological and physical) and social influences on disease presentations. Also, to establish and address peculiarities of migraine in children that would enable clinicians to advise on lifestyle modifications, co-morbid conditions and the correct choice of treatment options including non-pharmacologic therapies and medications. EXPERT OPINION The choice of treatment should be based on an assessment of each individual child taking into account, age, gender, pubertal status, body weight, comorbid disorders and family history. Also considering the profile of migraine episodes, frequency, duration, associated symptoms and effects of nausea and vomiting. Using the appropriate medications in appropriate dosage, formulation and route and timing of administration may improve adherence to treatment and outcome.
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Affiliation(s)
- Ishaq Abu-Arafeh
- Paediatric Neurosciences Unit, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
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15
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Knestrick KE, Gibler RC, Reidy BL, Powers SW. Psychological Interventions for Pediatric Headache Disorders: A 2021 Update on Research Progress and Needs. Curr Pain Headache Rep 2022; 26:85-91. [PMID: 35107711 PMCID: PMC8807374 DOI: 10.1007/s11916-022-01007-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review summarizes key findings from recent investigations of psychological interventions for pediatric headache disorders and discusses important avenues for future research. RECENT FINDINGS Cognitive Behavioral Therapy (CBT) is effective in reducing headache days among youth with chronic headache. There is mixed evidence for the benefit of CBT on reducing disability associated with migraine, suggesting that there is room to optimize CBT by leveraging complementary or alternative psychological interventions, such as Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches. Tailoring CBT may be especially important for youth with more impairing or complex clinical presentations, such as those with continuous headache. Using eHealth and novel study designs to expand access to and dissemination of psychological interventions is promising. Although CBT is the gold standard psychological treatment for youth with migraine, we are only beginning to understand how and why it is effective. Other promising psychological treatments are available, and studies are beginning to examine how CBT can be optimized to fit the unique needs of each patient. Improving access and equitability of care for youth with migraine will require tailoring psychological treatments for patients with varying headache presentations and youth from a variety of cultural, racial, ethnic, and linguistic backgrounds.
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Affiliation(s)
- Kaelynn E Knestrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Robert C Gibler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. .,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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16
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Abstract
Purpose of Review The diagnostic criteria of new daily persistent headache (NDPH) have been revised since 2013. The current review focused on the progress of NDPH research over the last few years. Recent Findings Various new triggers and different NDPH mimics have been reported. The association with both cephalic and extracephalic pathologies suggests that NDPH is rather a syndrome with more than one disease mechanism. Recent clinical studies confirmed that migrainous headache remained the most prominent phenotype of NDPH, echoing the change of the diagnostic criteria in 2013. Diagnostic workup, including imaging studies, was unremarkable, except serving to exclude secondary etiologies. Studies on treatment options have yet shown promising targets, and randomized clinical trials are still lacking. Summary Multiple mechanisms, both cranial and systemic, may be involved synergically in the generation of NDPH-like headaches. The search for effective treatment options should base on better understanding of disease mechanisms.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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17
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Lobo R, Wang M, Lobo S, Bahra A. Time to retire 'New daily persistent headache': Mode of onset of chronic migraine and tension-type headache. Cephalalgia 2021; 42:385-395. [PMID: 34579562 DOI: 10.1177/03331024211044440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically.Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders - 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome.Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate.Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.
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Affiliation(s)
- Rhannon Lobo
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK
| | - Mu Wang
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi Province, China.,Section for Nutrition Research, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, 4615Imperial College London, Imperial College London, London, UK
| | - Sean Lobo
- Faculty of Life Science and Medicine, King's College London, London, UK
| | - Anish Bahra
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, 9744Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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18
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Liu H, Ran Y, Dang L, Yang R, Sun S, Zhang M, Li K, Chen C, Dong Z, Yu S. Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study. PAIN MEDICINE 2021. [DOI: 10.31636/pmjua.v6i1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China.
Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone.
Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005).
Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.
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19
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Papetti L, Sforza G, Tarantino S, Moavero R, Ruscitto C, Ursitti F, Ferilli MAN, Vigevano F, Valeriani M. Features and Management of New Daily Persistent Headache in Developmental-Age Patients. Diagnostics (Basel) 2021; 11:diagnostics11030385. [PMID: 33668316 PMCID: PMC7996357 DOI: 10.3390/diagnostics11030385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Giorgia Sforza
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Samuela Tarantino
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Romina Moavero
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Fabiana Ursitti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Federico Vigevano
- Department of Neuroscience, Neurology Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Massimiliano Valeriani
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
- Correspondence: ; Tel.: +39-066-859-2289
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20
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Abstract
PURPOSE OF REVIEW Headaches are not only responsible for restrictions in everyday life in adults. In children and adolescents, regular headaches lead also to reduced life quality and limitations in the social sphere, in school education, and in professional careers. Here, we provide an overview on the frequency of headache in children and adolescents with the aim of increasing awareness about this particular health issue. RECENT FINDINGS Overall, headache prevalence in children and adolescents has been increasing in recent years. From various regions worldwide, data describing headache, its forms, and consequences are growing. In addition, factors frequently correlated with headache are repeatedly investigated and named: besides genetic factors, psychosocial and behavioral factors are linked to the prevalence of headache. Increasing evidence indicates that headache is underestimated as a common disorder in children and adolescents. Accordingly, too little emphasis is placed by society on its prevention and treatment. Thus, the extent of the social and health economic burden of frequent headaches in children and adolescents needs to be better illustrated, worldwide. Furthermore, the data collected in this review should support the efforts to improve outpatient therapy paths for young headache patients. Factors correlating with headache in pupils can draw our attention to unmet needs of these patients and allow physicians to derive important therapy contents from this data.
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Affiliation(s)
- Vera Nieswand
- Headache Clinic, Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Matthias Richter
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Headache Clinic, Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr 74, 01307, Dresden, Germany.
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