Although headaches remain for a majority of patients, the rates of disability are low.
TORONTO—About two-thirds of children and adolescents with new daily persistent headaches (NDPH) continue to have headaches six months to two years later, according to research presented at the 62nd Annual Meeting of the American Academy of Neurology.
Using a retrospective chart review, Sahithya Wintrich, BS, and A. David Rothner, MD, of the Department of Pediatric Neurology at the Cleveland Clinic, identified patients younger than 22 who were diagnosed with NDPH between 2001 and 2008. A total 5,844 headache cases were reviewed, and 51 (13 males) met the study criteria of age and diagnosis with new daily headache. The mean age of subjects was 15.7.
After sending consent letters to the families, the investigators followed up with a telephone survey. The researchers were unable to contact 12 patients and 11 patients refused to participate, leaving a total of 28 patients (24 females). Participants were asked about their current type of headache; its frequency, severity, quality, and associated symptoms; treatment method used; frequency and dosage of medicine used per week; and their disability assessment, using Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores.
Eight of the 28 patients reported being headache free at follow-up. Three achieved headache-free status within a year, four were free of headaches within two years, and one patient was free of headaches within three years. Of the remaining 20 patients, eight experienced more than 15 headaches a month, three had fewer than five episodic migraines, six had between five and 15 episodic tension-type headaches a month, and three experienced fewer than five headaches a month.
PedMIDAS scores ranged from 0 to 130, with an average of 11. Three patients reported mild disability, one reported moderate disability, and two reported severe disability due to their headaches.
“Data concerning the prognosis of NDPH are sparse in adults and adolescents,” the researchers noted. “Whether it is a single entity with multiple etiologies or represents multiple syndromes is unknown and would relate to the outcome. Our study indicates that 20 of 28 continue to have headache six months to two years later. However, 79% have PedMIDAS scores that indicate they are able to function well in school and at home, and are not significantly disabled by their headache.”
—Rebecca K. Abma
Suggested Reading
Kung E, Tepper SJ, Rapoport AM, et al. New daily persistent headache in the paediatric population. Cephalalgia. 2009;29(1):17-22.
Robbins MS, Grosberg BM, Napchan U, et al. Clinical and prognostic subforms of new daily-persistent headache. Neurology. 2010;74(17):1358-1364.
Wang SJ, Fuh JL, Lu SR. Chronic daily headache in adolescents: an 8-year follow-up study. Neurology. 2009;73(6):416-422.