A New Case of New Daily Persistent Headache Successfully Treated with Botulinum Toxin Type A

Abstract

Objective: Our study describes a typical case of New Daily Persistent Headache (NDPH), refractory to different therapies, that presented a sat-isfactory response to repeated cycles of botulinum toxin type A. Back-ground: New Daily Persistent Headache 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, being similar to chronic migraine without aura or tension-type headache. It may be self-limiting within months or years without therapy, or be refractory to most treatments. Case Report: A 56-year-old woman suffered since eleven years from a daily and continuous headache, pressing/tightening in quality and of moderate intensity, but with daily paroxysms of stabbing pain, without autonomic symptoms. No trigger factors of pain were detected. She experienced a remission period of three years, after that the pain relapsed with the same features. Neurological examination was negative, apart from minimal dysarthria. She was submitted to various examinations (including a complete psychiatric evaluation) and finally diagnosed as NDPH. Her pain was unresponsive to multiple pharmacological treatments. Results: After a week from first cycle of botulinum toxin type A (195 U) she experienced a satisfactory relief of pain and good improvement of her quality of life. Her pain relapsed shortly before subsequent administration of Botox and after a missed cycle: a good relief was subsequently obtained with further cycles of the treatment. Conclusions: This is our second case of NDPH successfully treated with Botulinum Toxin type A. We propose this treatment for refractory cases of chronic daily headaches, including NDPH.