Early treatment for new daily persistent headache associated with improved outcomes in children and adolescents
By Sravya Valiveti. This article was initially published in the 11/20/25 Edition of our Concussion Update newsletter; please consider subscribing.
A scientific abstract presented at the American Headache Society 67th Annual Scientific Meeting highlights that a combination of early interventions and therapies is crucial for alleviating symptoms in pediatric patients (ages 5-17) with new daily persistent headaches (NDPH). The retrospective study, authored by Christina L. Szperka, MD, and Amy A. Gelfand, MD., was discussed in a Helio article by Robert Herpen. Although NDPH is distinct from both concussion and persisting symptoms after concussion, these findings may be relevant to treating concussion-related post-traumatic headache.
The researchers assessed four treatment categories: preventive* medication, preventive supplements, preventive non-medication therapies, and bridge therapies (treatments used for severe and unusually prolonged headache). Results showed that each additional month after onset that patients failed to receive initial treatment was associated with a reduction in symptom improvement of more than 15%. Additionally, early treatment was associated with improved outcomes at 1 year, whereas prolonged delays in treatment reduced the odds of achieving this symptom improvement by the 1-year mark.
*Terminology Note: ‘preventive,’ or ‘prophylactic’ treatments are used to reduce the frequency, duration, and severity of headaches. ‘Preventive’ treatments are distinct from ‘rescue,’ ‘acute,’ or ‘abortive’ treatments, which are used at the onset of a headache (commonly for migraines) to relieve symptoms.
The researchers reviewed the charts of 172 patients aged 5 to 17 years who were treated at CHOP. Those with a clinical history of abrupt-onset, new, daily-persistent headaches with symptoms lasting at least one month were included. The mean baseline severity was reported as a 6 out of 10 on the pain scale, and half the cohort reported severe disability. Patients who presented to the ED with headaches received bridge therapy while transitioning to a formal treatment regimen, and patients who presented to the neurology department were started on bridge therapy at presentation.
For bridge therapies, the median time to treatment was 49 days, and the first bridge therapy used was beneficial for 57% of patients. Bridge therapies (such as IV medications), with a median time to treatment of 40 days, were beneficial for 83% of patients. For preventive supplements, the median time to treatment was 93 days. Riboflavin was found to be the most beneficial preventive supplement, with 36% of patients who used it experiencing documented improvement. For prescribed preventive medications, the median time to treatment was 69 days. The first type of medication used was beneficial for 35% of patients, but 24% were worse off after initiation; all other therapies had no adverse effects. For non-medication therapies, habit modification benefitted 47% of patients, neuromodulation device use benefitted 46% of patients, acupuncture benefitted 42% of patients, and cognitive behavioral therapy with biofeedback benefitted 36% of patients. Compared to preventive medications, non-medication treatments had significantly fewer outcomes in which patients worsened after initiation.
Dr. Szperka adds that patients are typically prescribed a preventive medication or a supplement as the main treatment during their visit to the neurology department, followed by non-medication therapies later as needed. She emphasizes that it’s important for patients not to ignore any headache symptoms and urges providers to use a combination of therapies early, i.e., start patients on bridge therapies, followed by preventive and/or non-medication therapies.
Dr. Szperka notes that reports of new daily persistent headaches in pediatric patients are a serious concern that cannot be overlooked, especially pertaining to delayed treatment initiation. She highlights that understanding other barriers to treatment and the impact of early, aggressive treatment strategies for NDPH should be thoroughly examined in future pediatric and adolescent headache studies to improve outcomes and inform future clinical trials to advance treatments.