Endogenous Modulation and Central Sensitization in New Daily Persistent Headache ( NDPH ) in Children
Endogenous Modulation and Central Sensitization in New Daily Persistent Headache ( NDPH ) in Children
New daily persistent headache (NDPH) is a primary headache disorder characterized by the
 daily and unremitting headache pain patients experience with a distinct onset. Despite the
 known significant impairment associated with NDPH, the process by which some patients with
 NDPH recover within months while others do not is unknown.

 The investigators propose to refine the clinical definition and suggest a novel mechanism
 underlying new daily persistent headache (NDPH) in adolescents. In non-responding patients,
 they further aim to investigate low-dose naltrexone for the treatment of new daily persistent
 headache.

 Adolescents ages 10-17 will be recruited from Boston Children's Hospital Pediatric Headache
 Program.
The purpose of this study is to investigate low-dose naltrexone for the treatment of new
 daily persistent headache (NDPH) in adolescents ages 10-17. New daily persistent headache
 (NDPH) is a primary headache disorder characterized by continuous pain experienced for at
 least 3 months from distinct onset. Patients with NDPH have compromised academic performance,
 school absence, anxiety, depressed mood, sleep impairment, family disruption, and high health
 care costs. Despite the known significant impairment associated with NDPH, the process by
 which some patients with NDPH recover within months while others do not is unknown. With the
 goal of enhancing the clinical definition of NDPH, investigators will describe differences
 between patients with NDPH who recover within a few months and those who do not.

 Additionally, little is known about which medications effectively manage and treat NDPH. One
 proposed medication that may benefit children and adolescents with NDPH is low-dose
 naltrexone. Naltrexone is an anti-inflammatory agent, similar to the opioid antagonist
 naloxone. Naltrexone is an effective treatment for opioid addiction, however, it was recently
 discovered that when taken in low doses (1/10 of the typical dose) naltrexone is capable of
 reducing the severity of chronic pain symptoms. By acting on glial cells in the nervous
 system as well as other receptors in the brain, naltrexone is capable of exerting analgesic
 effects. With this analgesic property, it has been speculated that low-dose naltrexone may be
 an effective treatment for the management of several chronic pain conditions, including
 headache.

 Although more research must be conducted to evaluate long-term effects of using low-dose
 naltrexone, prior studies show that there are little short-term consequences associated with
 using this drug as a form of treatment for chronic pain symptoms. Investigators aim to assess
 the efficacy and safety of low-dose naltrexone in the treatment of patients with NDPH.
Inclusion Criteria:

 1) Patients meeting clinical International Classification of Headache Disorders (ICHD-3
 )classification for NDPH 2) Age 10-17 years, all sexes, races, and ethnicities 3) English
 speaking 4) Able to wean off headache prophylactic medication 2 weeks prior to start of
 Naltrexone trial (patient will still be able to use abortive medication throughout the
 duration of the study) 5) On stable psychotropic medication for mild anxiety and/or mood
 disturbance for 2 weeks

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 Exclusion Criteria:

 1) Children and adolescents with significant chronic medical illness: Central Nervous
 systen (secondary headache disorder other than mild traumatic brain injury); Cardiac,
 Pulmonary other than stable asthma, Metabolic, Renal, Hepatic 2) Significant psychiatric
 disorder, such as major depression, somatization disorder, and psychosis 3) Pregnancy 4)
 Intellectual delay or cognitive limitations precluding completion of questionnaires or
 following instructions.

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