New Daily Persistant Headache

MHNI Headache Division discusses the diagnosis & treatment of New Daily Persistent Headache.

What is New Daily Persistent Headache?

New daily persistent headache (NDPH) is one of the important headache entities under the category of chronic daily headache. This is the group of primary headache disorders that also includes chronic migraine, chronic tension-type headache, and hemicrania continua. Only recently has NDPH been recognized as a distinct entity by headache specialists.

What key symptoms distinguish New Daily Persistent Headache?

New daily persistent headache is unique in that the headache is daily from onset, typically in a patient with no prior history. It can continue for years without any sign of alleviation despite aggressive treatment. The headache will start one day and in many instances continue as daily and unremitting pain.

There may be two subtypes of NDPH, a self-limited form which typically goes away within several months without any treatment, and a refractory form, which is difficult to treat.

A characteristic and unique feature of NDPH is that most patients are able to pinpoint the exact date when their headaches started. Headache onset may occur in relationship to an infection or flu-like illness (such as mononucleosis), surgery (such as hysterectomy), or a stressful life event. NDPH is 2½ times more likely to occur in women than men. Average pain intensity is moderate in most people, though some individuals experience severe pain all of the time.

In order to meet the diagnostic criteria for NDPH, daily pain must be present for more than two months with untreated headache duration greater than four hours a day. Headache location is typically on both sides of the head and anywhere around the head. Pain is usually throbbing or pressing in quality, with associated symptoms such as nausea, light sensitivity, sound sensitivity, or lightheadedness.

In order to diagnose New Daily Persistent Headache, what other disorders must commonly be ruled out?

The diagnosis of NDPH must occur after many other conditions that can produce daily persistent headache are ruled out by a series of tests and other measures.  Also the International Headache Society criteria must be met.  Most importantly, the physician must consider disorders that can mimic NDPH.

What treatment is available for New Daily Persistent Headache?

Primary NDPH is considered one of the more difficult headaches to treat, though many patients do respond to appropriate treatment.  Because some cases have features of migraine, patients may respond to migraine-type medication. Other patients respond to topiramate or gabapentin, which also can help some migraine patients. Pregabalin and many other drugs used for a variety of headache conditions are used by MHNI physicians to help patients with NDPH.  Nonetheless, of all the headache conditions, it is one of the more stubborn headaches and more challenging to treat.  Some patients require hospitalization to break the headache cycle.