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OnabotulinumtoxinA appears most beneficial and well-tolerated among treatments for youth with new daily persistent headache, while bridge therapies provide early relief; supplements and oral preventives show modest efficacy with some side effects.
A real-world study highlights the challenges and varying effectiveness of treatments for children and adolescents diagnosed with new daily persistent headache (NDPH)—a debilitating ailment marked by the sudden onset of continuous headache lasting at least 1 month. In this retrospective chart review conducted in a child neurology clinic, researchers analyzed the medical records of 172 patients (aged 5 to 17 years) who met the criteria for NDPH.
Treatment responses were assessed for commonly used therapies, based on documented benefits—defined as either remarkable (≥30% improvement lasting ≥4 weeks) or partial—and for adverse outcomes including side effects or worsening of symptoms. The study found that first-line bridge therapies, which typically encompassed intravenous medications with or without oral corticosteroids, provided the highest overall benefit, with 57% (62 of 108) of patients experiencing some degree of improvement.
OnabotulinumtoxinA (Botox) injections, though less commonly employed and initiated later in the treatment course, illustrated the highest benefit rate at 70% (14 of 20) and were notable for having no reported adverse outcomes. Among oral treatment options, supplements such as riboflavin and magnesium illustrated benefits in 31% (36 of 118) of patients and exhibited a very low rate of negative effects (3%). Prescription preventive medications, often amitriptyline or topiramate, yielded comparable benefits (35%, or 37 of 106) but were linked with a much higher rate of negative outcomes (24%, or 25 of 106).
The study also underscored a considerable delay in initiating treatment, with the median time to first therapy being 49 days for bridge treatments and as long as 144 days for non-pharmacological options like cognitive behavioral therapy. The authors emphasize that early intervention—especially combining bridge therapies with preventive treatments—may improve outcomes. They call for prospective natural history studies and formal clinical trials to guide better management strategies for pediatric NDPH.
Neurology
Effectiveness of Treatments used in New Daily Persistent Headache in Children & Adolescents (P5-12.001)
Nassim Abu-Halaweh et al.
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