Douglas Billing v. HHS - Tdap, new daily persistent headache (NDPH) (2025)

Douglas Billing, a 53-year-old man, filed a petition on May 14, 2018, alleging that the influenza and Tetanus, Diphtheria, and Pertussis (TDaP) vaccines he received on September 30, 2015, caused him to develop New Daily Persistent Headache (NDPH). Mr.

Billing reported waking up on October 3, 2015, with a severe, persistent headache that has not resolved. He experienced throbbing pain, intense pressure behind his eyes, ringing in his ears, and radiating pain down his neck and shoulders, with scalp tenderness.

His pain level worsened significantly over the following weeks, rendering him unable to drive or look at a computer screen. He had no prior history of headache disorders.

Over the next several years, Mr. Billing saw numerous physicians, including optometrists, primary care physicians, neurologists, and a headache specialist.

He underwent extensive diagnostic testing, including CT scans, MRIs, MRVs, and a lumbar puncture, and tried various treatments such as medications, injections, physical therapy, chiropractic care, and acupuncture, none of which provided lasting relief. In December 2017, a headache specialist, Dr.

Duren Michael Ready, diagnosed him with NDPH and noted that the vaccination was a reasonable suspected precipitating event. Petitioner's counsel was Sean Franks Greenwood of The Greenwood Law Firm.

Respondent's counsel was Ryan Daniel Pyles of the United States Department of Justice. Special Master Thomas L.

Gowen presided over the case. Petitioner presented expert testimony from neurologist Dr.

Marcel Kinsbourne and immunologist Dr. Omid Akbari.

Dr. Kinsbourne opined that Mr.

Billing met the diagnostic criteria for NDPH and that the vaccines likely triggered an autoimmune response leading to chronic inflammation and his headaches, possibly through inflammatory cytokines like TNFα affecting the meninges. Dr.

Akbari presented a complex theory involving the innate and adaptive immune systems, the inflammasome pathway, cytokine production (TNFα, IL-1), neuropeptide release (CGRP), and a failure of the regulatory immune system, exacerbated by the TDaP vaccine's adjuvant, to explain how the vaccines caused Mr. Billing's NDPH.

Respondent's experts, neurologist Dr. Dara Jamieson and immunologist Dr.

Andrew Saxon, argued that NDPH is a descriptive syndrome without a known pathophysiology and that the vaccines were not the cause of his condition. Dr.

Jamieson stated that NDPH is not a disease entity but a descriptor for headaches with a specific temporal profile, and that there is no known autoimmune pathophysiology for chronic primary headache disorders. Dr.

Saxon contended that the vaccines do not generally lead to systemic inflammation or changes in immune mediators and that there is no accepted hypothesis for an autoimmune cause of chronic headaches. Special Master Gowen found that Mr.

Billing had established a defined and recognized injury (NDPH) and met the three prongs of the Althen test for off-Table claims. He determined that petitioner's experts provided a sound and reliable theory of causation, supported by circumstantial evidence, and that there was a proximate temporal relationship between the vaccinations and the onset of symptoms.

The Special Master ruled that Mr. Billing is entitled to compensation, with damages to be determined in a separate ruling.

The decision date was March 13, 2026.