About 5 years ago, we started an initiative for the treatment of New Daily Persistent Headache. We have a large population of teens with this difficult, constant headache. There’s a reason why they call it persistent, as it is fairly refractory to treatment with the usual headache/migraine approaches, and the average lifespan of NDPH is 3 years. It behaves like both tension-type and migraine headache and is more of a chronic pain condition. So we decided to try a more chronic pain approach to NDPH.
Intermittent IV infusions of lidocaine have been used for years to deal with and reduce chronic and/or neuropathic pain. Our pediatric chronic pain colleagues have been using a short-duration infusion of lidocaine in the outpatient setting to treat chronic pain, with generally good results. We started using the same dosing of lidocaine, using the same protocol. We developed a database to collect certain measures, in the hopes that there would be positive results to report. We collected data for several years, stopping only when the Covid 19 pandemic happened. Interestingly, there seems to be some correlation to the long-Covid phenomenon and NDPH.
I was initially disappointed at the results; in my dreams, I had hoped that there would be a miraculous reduction or even resolution of all pain and symptoms. I was weary of my patients just not getting better, despite our best efforts, and felt so sad for the teens and their families.
So what really happened…..The pain did not get miraculously better, but in a number of cases, there was pain reduction. Even more impactful, there seemed to be a significant reduction in the associated symptoms they suffered (fatigue, mental fog, persistent nausea, dizziness). The positive results seemed sustained for at least 1 month. One of my favorite patients said to me: “I can tolerate the constant headache pain but the other symptoms on top of this pain make it unbearable. After the lidocaine, the symptoms got so much better, and I was able to function, get my schoolwork done, and tolerate the pain. My life got better!” Phew……I felt better after that. And it seemed that there had been no significant negative effects after infusion, so I was able to say to my teens- it might make you better, it might do nothing, but we know it won’t make you worse. With NDPH, you don’t get to say that very often.
We finally got around to looking at the data we collected, and there was a lot of it. We asked about pain scores, pain duration, symptoms, side effects and functionality at pre-infusion, 1 day post-infusion, 1 week post-infusion, and 1 month post-infusion points. The results were significant in a number of areas. We are submitting the results in a poster, and then planning to write up a paper about it. It is called “safety and efficacy of short duration lidocaine infusions for adolescents with new daily persistent headache”. Here are some of the result highlights:
Safety was measured via self-reported side effects at all timepoints. Efficacy was measured via self-reported numeric pain scores, headache frequency, associated symptoms, and functioning at all timepoints. With regard to safety, there were transient side effects in about 37% of patients during infusion, and only 6% reported any side effects the day after, and none after that time. These decreases were statistically significant. No patients reported severe side effects at any timepoint in this study.
With regard to efficacy, there were significant decreases in pain severity, decreases in associated symptoms,
and increases in function from day of infusion to 1 week after, and also from day of infusion to 1 month after infusion. There were more patients than expected transitioning from daily headaches to episodic or no headaches. Most patients reported an improvement in associated symptoms, which was significant
and sustained for more than 1 month.
For patients who have few effective treatment options, short duration lidocaine infusions could represent some hope for improvement in headache, overall functioning, and quality of life. This promising treatment option offers another tool in treating this difficult headache condition.
HeadFirst PNP 