The Three T's of NDPH (How Clinical Observations Have Led to Improved Treatment Outcomes)

Rozen, Todd D.

doi:10.1111/head.13624

Cited by 14 publications

(25 citation statements)

References 13 publications

(28 reference statements)

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“…The triggers of NDPH have garnered interest as to their particular relevance. Our cohort had a lower proportion of triggering events, which may have been elucidated with more in-depth scrutiny (29).…”

Section: Discussionmentioning

confidence: 99%

Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache

et al. 2021

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New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically. Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders – 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome. Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate. Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.

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Section: Discussionmentioning

confidence: 99%

Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache

et al. 2021

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“…NDPH has two subtypes: a self-limiting subtype that typically resolves within several months without therapy and a refractory subtype that is resistant to aggressive treatment regimens [1]. Vanast first found that 78 % of patients became headache-free by 24 months [21] and considered NDPH a benign headache. In contrast, most subsequent studies considered it to be the most refractory to treatment and can persist for many years [2].…”

Section: Treatment and Prognosis Of Ndphmentioning

confidence: 99%

RETRACTED: Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study

Liu

Dang

et al. 2021

PMJUA

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Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China. Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone. Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005). Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.

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“…59 Rozen described three “Ts” (trigger, Trendelenburg response, and thunderclap headache) on history and examination to further characterize the NDPH subtype, need for more work-up, pathophysiologic suspicion, and the treatment plan. 71 NPDH can sometimes present initially as a thunderclap headache, in which case RCVS has to be considered. 59 Persistent headache after the thunderclap headache at the onset of RCVS has been observed, and nimodipine may help in those cases.…”

Section: Definition and Differential Diagnosismentioning

confidence: 99%

Refractory Headaches

Dhaem

Rizzoli

2022

Semin Neurol

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Medication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.

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The Three T's of NDPH (How Clinical Observations Have Led to Improved Treatment Outcomes)

Cited by 14 publications

References 13 publications

Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache

Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache

RETRACTED: Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study

Refractory Headaches

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