Headache trajectories in children and adolescents with new onset continuous headache.

BACKGROUND

New daily persistent headache (NDPH) is a challenging and understudied primary headache disorder with no known effective treatment. Although the International Classification of Headache Disorders criteria require that the new onset continuous headache be present for at least three months before diagnosing NDPH, the biologic basis for when a new, continuous headache starts to behave as NDPH is unknown, and some pediatric headache experts consider that the minimum duration criterion could be shorter.

METHODS

In this retrospective study, we reviewed the intake questionnaires and medical records of 5-17 year-olds seen in neurology clinic for headache at the Children's Hospital of Philadelphia. Those with a new onset continuous headache of at least one month in duration were eligible. The patient's self-report and clinician's description both had to indicate that the headache was new, of abrupt onset, and continuous to be included, although patients were allowed to have a prior history of infrequent headaches. We compared headache outcomes at last follow-up and at one year after continuous headache onset between those who had a continuous headache duration of 1 to <3 months ("new onset headache", or NOH) at first visit vs. those with ≥3 months (NDPH). We used multivariate regression modeling to examine for predictors of headache outcomes.

RESULTS

Of 472 patient records reviewed, 172 met the inclusion criteria for analysis. Of these, 84 had a headache duration of 1 to <3 months in duration and 88 had a duration of ≥3 months. Those with shorter duration continuous headache were younger (median (interquartile range) 13.5 (11.1-15.7) vs. 15.1 (12.3-16.5) years, and less likely to have previously received a prescription preventive for the continuous headache (n = 14 (17%) vs. 26 (30%), p = 0.046), but were otherwise similar to those with NDPH in terms of baseline clinical and demographic variables. Sixty-five (74%) of those with NDPH and 60 (71%) with NOH had follow-up data. At last clinic follow-up, 41/65 (63%) with NDPH and 43/60 (72%) with NOH had experienced any headache benefit (

CONCLUSIONS

Headache outcomes of children and adolescents with new onset continuous headache, whether of 1 to <3 months (NOH) or ≥3 months in duration (NDPH) are suboptimal. More research is needed to improve treatment outcomes for this patient population.

Déclaration de conflit d'intérêts

Declaration of conflicting interestsCS: Dr Szperka or her institution have received compensation for serving as a consultant for AbbVie and Teva. She has received personal compensation for serving on a data safety monitoring board for Eli Lilly and Upsher-Smith. She has also received research support from the NIH NINDS (K23NS102521), PCORI and the CHOP CARES/ Doris Duke COVID-19 Fund to Retain Clinical Scientists. ME: None. CPG: Dr Patterson Gentile has received salary support from grants from the American Academy of Neurology Clinical Research Training Scholarship in the past 24 months, and is currently funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke (K23 NS124986). PP: None. NR: None. BMP: None. ADH: Dr Hershey or his institution have received compensation for serving as a consultant for AbbVie, Amgen, Biohaven, Eli Lilly, Lundbeck, Supernus, Teva, Theranica and Upsher-Smith. His institution has also received research support from Amgen, Biohaven, Eli Lilly, Theranica, Upsher-Smith, and the NIH NINDS/NICHDS. AAG: In the last 24 months, Dr Gelfand has received honoraria from UpToDate (for authorship) and from the Headache Cooperative of the Pacific and the Taiwan Headache Society for speaking. She receives payment to her institution from the American Headache Society for her role as Editor of