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New Daily Persistent Headache and OnabotulinumtoxinA Therapy

Ali, Ashhar, DO*; Kriegler, Jennifer, MD; Tepper, Stewart, MD; Vij, Brinder, MD§

doi: 10.1097/WNF.0000000000000313
Original Articles

Objective The aim of the study was to determine whether onabotulinumtoxinA therapy is effective in the treatment of new daily persistent headache (NDPH).

Background New daily persistent headache is a difficult to treat headache syndrome resistant to both conventional and unconventional headache therapies. New daily persistent headache was excluded in the registration trials for onabotunlinumtoxinA (onabot) in chronic migraine. Apart from case reports supporting its benefit, little is known about its therapeutic value in NDPH.

Design and Methods We performed a single-center, retrospective chart review of patients with a diagnosis of NDPH who received onabot treatment for a 30-month period at the Cleveland Clinic Headache Center. Measures of interest were headache frequency and headache severity. All patients had received the Food and Drug Administration–approved PREEMPT Protocol.

Results A decrease in headache frequency was noted in 8 (50.0%) of 16 patients at 6 months and 7 (63.6%) of 11 patients at 12 months. Headache severity improved in 5 (50.0%) of 10 patients at 6 months and in 7 (77.8%) of 9 patients at 12 months.

Conclusions Most therapies are unable to break the unremitting course of NDPH. In our investigation, at 1 year (3–4 cycles of onabot treatment), approximately half of the patients treated showed a reduction in headache frequency and approximately 75% demonstrated some improvement in headache severity. Evidence from this small-scale retrospective study suggests that onabot shows strong promise for the treatment of NDPH, which currently is resistant to most therapies, but a randomized controlled study should be the next step in confirmation of this therapy.

*Department of Neurology, Henry Ford Health System, Detroit, MI;

Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, OH;

Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and

§Neurology & Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnnati, OH.

Address correspondence and reprint requests to Ashhar Ali, DO, Department of Neurology, Henry Ford Health System, 6777 W Maple Rd, West Bloomfield Twp, MI 48322; E-mail:

J.K. received an unrestricted Educational/Research Grant from Allergan. S.T. serves as consultant and is on advisory board for Allergan and receives research support (no personal compensation) from Allergan and Royalties from Springer.

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