New daily persistent headache (NDPH) is “rare” and “poorly understood;” there is “no known treatment for NDPH.” These statements, which are from abstracts of two studies that were presented at the American Headache Society’s conference in June, succinctly capture the frustrations of people living with NDPH. These studies provide some insight into NDPH.
Characteristics & Precipitating Factors of NDPH
An examination of patients with NDPH at Stanford’s headache clinic revealed some interesting details about the characteristics of NDPH:
- Patients most often described the pain as pressure-like and in the front of the head
- 75% said the pain was on both sides of the head (not one-sided, like migraine commonly is)
- 69% had migraine-like features to their headaches (46% of those had photophobia, 46% had phonophobia, 37% had nausea)
- 17% had a history of episodic migraine or another headache disorder prior to the NDPH diagnosis
- 53% had a family history of headaches
In addition, 75% of patients could identify an event or illness that immediately preceded the headache’s onset:
- 48% had an infection (usually viral)
- 26% had undergone recent surgery
- 7.4% had physical trauma
- 7.4% had psychological stress
- 11% had another precipitating event
This research is important to both understand NDPH better and to help classify whether it is a primary or secondary headache disorder, which can influence how it is treated.
Botox for NDPH
Perhaps more interesting for people with NDPH is a study of Botox as an NDPH treatment. In this study, 22 patients received Botox injections and 95.4% percent had multiple rounds of injections. Following the injections:
- 4.6% of patients had 21-30 headache-free days a month
- 18.1% had 11-20 headache-free days a month
- 9.1% had 0-10 headache-free days a month
- 68.2% had no decrease in headache days
Researchers also looked at a reduction in pain severity.
- 13.6% had a greater than 50% decrease in headache severity
- 54.6% had less than a 50% decrease in headache severity
- 31.8% had no change in headache severity
The numbers aren’t staggering, but 32% of patients did have at least some headache-free days with Botox. That’s not trivial for people who have received no other relief.
This was a small retrospective study. It’s results point to the need for more research on Botox for NDPH.