2025 American Academy of Neurology Abstract Website

Objective:

To describe real-world effectiveness of treatments used in children and adolescents with new daily persistent headache (NDPH).

Background:

NDPH is a primary headache disorder that often presents in adolescence and can be difficult to treat. In this study, we explored the relative benefit of treatments used for NDPH.

Design/Methods:

This was a retrospective chart review study. Patients aged 5-17yo with possible NDPH were identified based on patient responses to a Headache Questionnaire in child neurology clinic, confirmed with chart review, allowing abrupt onset continuous headache of at least 1month duration. We included treatments started during continuous headache until both break in continuous headache and sustained improvement in headache. For treatments tried by ≥10 patients and for the first treatment tried in each category, we calculated proportions of any documented benefit (significant(≥30% lasting ≥4 weeks) +some improvement) or negative outcome (worsened+side effects), as well as median time to treatment. Treatments may have overlapped.

Results:

172 charts were reviewed. First bridge therapy, usually IV medications ± oral corticosteroids, provided benefit to the largest proportion overall (62/108, 57%). First supplement, usually riboflavin ± magnesium, offered benefit in (36/118, 31%), with few negative outcomes (3/118, 3%). First prescription preventive, usually amitriptyline or topiramate, offered similar benefit (37/106, 35%) as first supplement, but with more negative outcomes (25/106, 24%). Despite being tried after oral preventives, onabotulinumtoxinA injections offered benefit to the largest proportion (14/20, 70%) without negative outcomes (0%). Overall, time to first therapy was far into continuous headache – shortest for bridge therapies (median 49 days, IQR 17-92), longest for non-medication treatments such as cognitive behavioral therapy (median 144 days, IQR 61-381).

Conclusions:

Youth with NDPH experience treatment delays which may hamper benefit. Clinicians should consider use of bridge therapies in combination with preventive treatments as early as possible. Prospective natural history studies and formal trials are needed.