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New Daily Persistent Headache in the Pediatric and Adolescent Population: An Updated Review
Paige Kalika1, Teshamae S Monteith2
1Division of Pediatric Neurology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Insights
New daily persistent headache (NDPH) is a challenging condition in children and adolescents. While research shows treatment overlap with chronic migraine, new therapies like CGRP antibodies offer hope for this understudied disorder.
Area of Science:
- Neurology
- Pediatric Headache Disorders
Background:
- New daily persistent headache (NDPH) is a primary headache disorder with sudden onset and intractable pain.
- It is more common in children and adolescents but remains underdiagnosed and understudied.
Purpose of the Study:
- To provide a comprehensive overview of NDPH in pediatric and adolescent populations.
- To cover history, pathophysiology, clinical findings, and treatment options.
Main Methods:
- Review of recent studies and meta-analyses on pediatric NDPH.
- Analysis of neuroimaging findings and treatment efficacy.
Main Results:
- Significant phenotypic overlap exists between pediatric chronic migraine and NDPH.
- Conflicting data on medication overuse in pediatric NDPH.
- Neuroimaging reveals altered functional connectivity in NDPH patients.
- Many patients are refractory to traditional treatments, but CGRP monoclonal antibodies show promise.
Conclusions:
- NDPH is a difficult-to-manage condition in pediatric patients, with limited research guiding treatment.
- Early pharmacological and non-pharmacological interventions are crucial to reduce disability.
- Further research is needed to understand pathogenesis and develop effective therapies.
Purpose Of Review:
New daily persistent headache (NDPH) is a primary headache disorder characterized by the sudden onset of continuous pain and its intractability to treatment. It is more prevalent in the pediatric population than the adult population, but remains understudied and underdiagnosed. The purpose of the current article is to provide a current overview of new daily persistent headache in the pediatric and adolescent population, including history, pathophysiology, clinical findings, current and emerging treatment options, and the results of recent studies and meta-analyses.
Recent Findings:
Despite recent studies and meta-analyses showing significant phenotypic overlap between chronic migraine and NDPH in the pediatric population, multiple recent studies have come to conflicting conclusions about the overlap of medication overuse in headache and pediatric NDPH. Recent studies reveal alterations in neuroimaging, particularly in functional connectivity, in patients with NDPH. Patients frequently remain treatment-refractory even to medications that have historically proven helpful in this population; however, new treatment options, including calcitonin gene-related peptide (CGRP) monoclonal antibodies, may be more effective.
Summary:
NPDH remains a perplexing and difficult-to-manage condition for both children and adults. Despite a higher prevalence in the pediatric population, there are relatively few studies to guide the evaluation and treatment of NDPH in pediatric and adolescent patients. Early treatment, both pharmacological and non-pharmacological, should be employed to reduce disability. Overall, further studies are needed to better understand pathogenesis and to identify more effective therapeutic strategies, both pharmacological and non-pharmacological.
