Abstract Details

Title Effectiveness of Treatments used in New Daily Persistent Headache in Children & Adolescents

Topic Headache

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-001

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.

Authors/Disclosures
Nassim Abu-Halaweh PRESENTER	Mr. Abu-Halaweh has nothing to disclose.
Amy Gelfand, MD (UCSF)	An immediate family member of Dr. Gelfand has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Arialys. Dr. Gelfand has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Headache Society. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of an immediate family member of Dr. Gelfand has received research support from Hoffman LaRoche. The institution of an immediate family member of Dr. Gelfand has received research support from Vigil Neuroscience. The institution of an immediate family member of Dr. Gelfand has received research support from NIH/NINDS. The institution of Dr. Gelfand has received research support from PCORI. The institution of Dr. Gelfand has received research support from UCSF RAP grant. Dr. Gelfand has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Gelfand has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Gelfand has received publishing royalties from a publication relating to health care. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Weill Cornell Neurology Department. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Taiwan Headache Society. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as a Author with Elsevier. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as a Speaker with College Board SSD. Dr. Gelfand has received personal compensation in the range of $0-$499 for serving as a Speaker with Kobenhavns Unversitet. An immediate family member of Dr. Gelfand has a non-compensated relationship as a Clinical Trial Steering Committee Member with Roche/Genentech that is relevant to AAN interests or activities.
Morgan Evans (Children's Hospital of Philadelphia)	Morgan Evans has nothing to disclose.
Blanca Marquez de Prado	An immediate family member of Blanca Marquez de Prado has stock in Latus Bio. An immediate family member of Blanca Marquez de Prado has received intellectual property interests from a discovery or technology relating to health care.
Carlyn Patterson Gentile, MD	The institution of Dr. Patterson Gentile has received research support from NIH/NINDS. The institution of Dr. Patterson Gentile has received research support from Children's Hospital of Philadelphia. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Faculty, Annual Scientific Meeting, Scottsdale Meeting with American Headache Society. Dr. Patterson Gentile has received personal compensation in the range of $5,000-$9,999 for serving as a Early Career Awardee with American Headache Society. Dr. Patterson Gentile has received personal compensation in the range of $0-$499 for serving as a Research Prize Awardee and travel expense coverage with NIH Pain Consortium. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Faculty, Speaker with Headache Cooperative of New England. Dr. Patterson Gentile has received personal compensation in the range of $500-$4,999 for serving as a Speaker, Awardee with ��ɫ��.
Nichelle Raj	Nichelle Raj has nothing to disclose.
Andrew D. Hershey, MD, PhD, FAAN, FAHS, FAAN	The institution of Dr. Hershey has received personal compensation in the range of $0-$499 for serving as a Consultant for Amgen. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upsher-Smith. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. The institution of Dr. Hershey has received research support from Amgen. The institution of Dr. Hershey has received research support from NIH, NINDS. The institution of Dr. Hershey has received research support from Bioahaven. The institution of Dr. Hershey has received research support from Upsher-Smith. Dr. Hershey has received publishing royalties from a publication relating to health care.
Christina L. Szperka, MD, FAAN (Children's Hospital of Philadelphia)	The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Upsher Smith. The institution of Dr. Szperka has received research support from PCORI. Dr. Szperka has a non-compensated relationship as a Cochair Scientific Committee with American Headache Society that is relevant to AAN interests or activities.

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