New daily persistent headache (NDPH) & onabotulinumtoxina therapy
Ali A, Kriegler J, Tepper S, and Vij B. New daily persistent headache (NDPH) & onabotulinumtoxina therapy. Neurology 2018; 90(15 Suppl 1).
Objective: To determine whether onabotulinumtoxinA therapy is effective in the treatment of New Daily Persistent Headache (NDPH). Background: New Daily Persistent Headache (NDPH) is a difficult to treat headache syndrome resistant to both conventional and unconventional headache therapies. NDPH was excluded in the registration trials for onabotunlinumtoxinA (onabot) in chronic migraine. Apart from case reports supporting its benefit, little is known about its therapeutic value in NDPH. Design/Methods: We performed a single center, retrospective chart review of patients with a diagnosis of NDPH who received onabot treatment over a 30 month period. Measures of interest were headache frequency and headache severity. After excluding patients seen at the Cleveland Clinic outside of the Headache Center, patients with missing data at baseline, patients that no longer had daily headache, and patients without valid data at any follow-up time point, there were 19 patients for frequency analysis and 14 for severity analysis. All patients had received the FDA-approved PREEMPT Protocol. Results: A decrease in headache frequency was noted in 8/16 (50.0%) patients at 6 months and 7/11 (63.6%) at 12 months. Using mixed effect logistic regression models, which account for loss-to-follow-up, the estimated percentage improving at 6 months was 49.7%, and at 12 months, 58.3%. Headache severity improved in 5/10 (50.0%) of patients at 6 months and in 7/9 (77.8%) at 12 months. Using mixed effect logistic regression models, the estimated percentage improving at 6 months was 50.0%, and at 12 months, 78.1%. Conclusions: Most therapies are unable to break the unremitting course of NDPH. In our investigation, at 1 year (3- 4 cycles of onabot treatment), approximately half of the patients treated showed a reduction in headache frequency and approximately 75% demonstrated some improvement in headache severity. OnabotulinumtoxinA may be a reasonable choice in the treatment of NDPH, but a randomized controlled study should be the next step.
15 Suppl 1