New Daily Persistent Headache Treated with Botulinum Toxin Type A: Case Report

Special Article – Headache

Austin J Anat. 2018; 5(2): 1082.

New Daily Persistent Headache Treated with Botulinum Toxin Type A: Case Report

Marco Trucco* and Ruiz L

Department of Neurology, Headache Centre, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy

*Corresponding author: Marco Trucco, Department of Neurology, Headache Centre, Santa Corona Hospital, Via XXV aprile 38, Pietra Ligure, SV, 17027, Italy

Received: March 27, 2018; Accepted: April 24, 2018; Published: May 01, 2018

Abstract

New Daily Persistent Headache (NDPH) is a primary headache disorder, characterized by chronic and unremitting daily headache with abrupt onset and more than three months in duration. It lacks typical clinical features. It may be self-limiting within months or years without therapy, or be refractory to most treatments.

Our study describes a typical case of New Daily Persistent Headache, refractory to different therapies that was partially responsive to repeated cycles of botulinum toxin type A. A 19-year-old woman, without prior headache history, suffered since eight months from a daily and unremitting headache, with features of tension-type headache. She was submitted to various examinations and finally diagnosed as NDPH. Her pain was unresponsive to multiple pharmacological and non-pharmacologic treatments. After three cycles of botulinum toxin type a she experienced a satisfactory relief of pain and good improvement of her quality of life. We propose botulinum toxin type A as an effective treatment for refractory cases of NDPH.

Keywords: Headache; Chronic headache; Headache therapy; New daily persistent headache; Botulinum toxin type A

Abbreviations

NDPH: New Daily Persistent Headache; EBV: Epstein-Barr Virus; HSV: Herpes Simplex Virus; CMV: Cito Megalo Virus; CSF: Cerebro Spinal Fluid; TNF?: Tumor Necrosis Factor Alfa; CNS: Central Nervous System; VAS: Visual Analogue Scale; EEG: Electro Encephalo Gram; MRI: Magnetic Resonance Imaging; DWI: Diffusion Weighted Image; EBNA: Epstein-Barr Nuclear Antigen; VZV: Varicella-Zoster Virus; NSAIDs: Non-Steroideal Anti- Inflammatory Drugs; PREEMPT: Phase III Research Evaluating Migraine Prophylaxis Therapy; QoL: Quality of Life.

Case Presentation

New Daily Persistent Headache (NDPH) is a primary headache disorder, characterized by chronic and unremitting daily headache with abrupt onset and more than three months in duration, first described by Vanast [1] in 1986 and later clinically better characterized [2-3]. It lacks typical clinical features, the pain being suggestive of chronic migraine without aura or tension-type headache. A percentage of NDPH sufferers may report some trigger events such as a febrile illness, surgical interventions or stressful events. It has two subtypes: it may be self-limiting within months or years without therapy, or be refractory to most treatments, frequently representing a major therapeutic challenge. The pathogenesis of NDPH is unknown, but in some cases association with viral infections (EBV) [4], (HSVCMV) [5], and elevation of CSF Tumor Necrosis Factor ? (TNF?) levels, a pro-inflammatory cytokine involved in brain immune and inflammatory processes [6], were reported. A pathogenetic hypothesis is a CNS inflammation triggered by a viral infection. One paper described widespread joint hypermobility, specifically in the cervical spine, as a predisposing factor for the development of NDPH [7]. It appears in the International Classification of Headache Disorders, 3rd Edition, in the fourth chapter (Other primary headache disorders) at the point 4.10 [8] (Table 1).

Citation: Marco Trucco and Ruiz L. New Daily Persistent Headache Treated with Botulinum Toxin Type A: Case Report. Austin J Anat. 2018; 5(2): 1082.