Treatment for new daily persistent headache usually begins with treating an underlying condition that may be causing the headaches. However, this headache syndrome often remains resistant to treatment (refractory), in which case treatment focuses on preventing and alleviating pain.
Medications for new daily persistent headache include antidepressants, such as nortriptyline (Pamelor); selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem, or others); beta blockers, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL), and propranolol (Inderal, Innopram XL); anti-seizure medications, such as topiramate (Topamax, Qudexy XR), divalproex sodium (Depakote), and gabapentin (Neurontin, Gralise); non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Anaprox, Naprelan); botulinum toxin (Onabotulinum toxin A ); and tetracycline derivatives, such as doxycycline.
Combined drug therapies may also be used, such as nortriptyline and topiramate; gabapentin and topiramate; clonazepam, botulinum toxin A, and mexiletine; doxycycline and montelukast; or intravenous methylprednisolone, intravenous sodium valproate, anti-depressants (amitriptyline or dothiepin), and naproxene.
Treatments for patients who do not respond to prophylactic (preventive) drugs include peripheral nerve blocks with 0.5% bupivacaine, ketamine infusion, intravenous lidocaine, intravenous methylprednisolone, and osteopathic manipulation therapy.