New Daily Persistent Headache

The Basics

New daily persistent headache (NDPH) is a primary headache disorder. It is termed “primary” because it’s not caused by another condition or disorder. The name “new daily persistent headache” describes the hallmark features of this headache:

• New- a headache developing in a person who either has no prior history of headaches or if they have a history of headaches, they should not describe increasing headache frequency prior to its onset. An important feature of NDPH is the clearly remembered onset; people often are able to describe the exact date or even moment the headache started.
• Daily- since onset of the headache, it has occurred on a daily basis.
• Persistent- it has been present for over 3 months with continuous pain.
• Headache- the headache associated with NDPH often resembles migraine in its features, with days when there is light or sound sensitivity, nausea, and throbbing pain. Or it may resemble a tension-type milder headache without any of those features.

People with new or never-evaluated NDPH should be carefully assessed by their doctor for an underlying cause. As well, they should be evaluated to make sure that they do not have a different primary headache disorder that can mimic NDPH. Other primary headache disorders that mimic NDPH include: chronic migraine, chronic tension-type headache, hemicrania continua, or medication overuse headache. NDPH can be distinguished from these other primary headache disorders because with NDPH the person can clearly remember the onset of headache and often they do not have any significant prior history of headaches, while with the other diagnoses the person may describe an increasing frequency of headaches culminating in a daily, continuous headache.

About half the time NDPH starts in the context of an infectious illness or a surgery, but often there is absolutely no clear trigger.

Please refer to the International Classification of Headache Disorders 3^rd edition (beta version) website for more information on the criteria used to diagnosis new daily persistent headache: https://ichd-3.org/other-primary-headache-disorders/4-10-new-daily-persistent-headache-ndph/.

Diagnosis

As mentioned above, other conditions must be ruled out before arriving at a diagnosis of NDPH. Investigations often include bloodwork, particularly looking for metabolic, infectious or inflammatory conditions, brain and vessel imaging, and lumbar puncture (spinal tap) with opening pressure. Two conditions in particular that must be ruled out are cerebrospinal pressure issues (either high pressure like pseudotumor cerebri or low pressure like spontaneous cerebrospinal fluid (CSF) leak) and cerebral venous sinus thrombosis. Headache from a CSF pressure issue is usually affected by body position (i.e. worse with laying or standing), but the longer it continues, the less apparent that becomes. Therefore, people may not think to mention that their headache was, at one point, affected by body position, and that may be missed.

Treatment

NDPH is treated like the headache it most resembles, generally chronic migraine or chronic tension-type headache. NDPH can be difficult to treat and thus very disabling. But it is important to remember that often people can be helped. Use of acute medications should be limited and barbiturates and narcotics avoided as much as possible in an attempt to reduce the risk of developing medication overuse headache in addition.

Summary

New daily persistent headache is now classified as a primary headache disorder. As you look at the symptoms, you’ll find that some of them are characteristic of tension-type headache, while others are more characteristic of migraine disease. NDPH is unique in that many people can tell you the exact date when their headache began. It is characterized by continuous daily head pain, varying in intensity, and sometimes accompanied by some migrainous symptoms. It is important that NDPH be diagnosed carefully and correctly after ruling out other conditions that can present with the same symptoms. Unfortunately, at this time, there are no treatments specifically outlined for NDPH.

References:

The International Headache Society. https://www.ichd-3.org/other-primary-headache-disorders/4-10-new-daily-persistent-headache-ndph/
Goadsby, Peter J., MD, PhD, DSc, FRACP, FRCP; Silberstein, Stephen D., MD, FACP; Dodick, David W., MD, FRCPD, FACP. “Chronic Daily Headache for Clinicians.” Hamilton, Ontario: BC Decker. 2005.
Li, D & Rozen, TD (2002). “The clinical characteristics of new daily persistent headache.” Cephalalgia22 (1), 66-69. doi: 10.1046/j.1468-2982.2002.00326.x.