A headache that begins suddenly then occurs every day over a long time is called a new daily persistent headache (NDPH). The defining feature of this type of headache is that you vividly remember the circumstances, sometimes even the exact date, of the first headache.
According to the 3rd edition of the International Classification of Headache Disorders, to be classified as NDPH, a headache must include the criteria below.
characteristics of NDPH
- The headache becomes persistent, occurring every day, within 24 hours of onset.
- The onset is clearly remembered and can be pinpointed.
- The headache is continuous for three months or more.
- It’s not caused by another underlying condition.
- The headache isn’t previous chronic headaches occurring more often.
NDPH is a subtype of chronic headache, which means a headache that lasts at least four hours and occurs at least 15 days a month for three months or longer. The headache pain can be similar to other types of chronic daily headache, including:
Symptoms common to all cases of NDPH are remembering its onset, which is sudden, and having persistent daily headache.
Because the diagnosis is based on its memorable onset instead of specific characteristics, such as type and location of pain, other symptoms vary from person to person.
symptoms of ndph involve headache pain that:
- is usually either throbbing like a migraine or tightening like a tension headache
- sometimes has migraine-like associated symptoms of nausea and vomiting or sensitivity to light, called photophobia
- is usually on both sides of the head but can be only on only one side
- is usually moderate to severe
- may get better or worse over the day
Chronic daily headaches are either primary with an unknown cause, or secondary where the cause is another underlying condition. NDPH is always a primary condition. If a secondary cause is found, the diagnosis is the underlying condition. These include:
There aren’t any known risk factors, but there may be triggers.
common triggers for ndph
In a study published in
Headache, possible triggering events were:
- an infection or viral illness
- surgical procedure
- stress-causing life events
There are two subtypes of NDPH:
- Self-limiting. This type goes away on its own with or without treatment, usually within two years of onset.
- Refractory. This type doesn’t respond to any treatment, and the headaches may continue for many years.
Very few studies have been done on the treatment of NDPH, and no medication has been proven to be effective. Initial treatment is usually based on the type of headache the symptoms resemble the most: migraine or tension. Your doctor may give you different medications to try to find out what works best.
Medications that might be used include:
- antiseizure medication, such as gabapentin (Neurontin) or topiramate (Topamax)
- triptans typically used for migraine, such as almotriptan (Axert) or sumatriptan (Imitrex)
- muscle relaxants, such as baclofen or tizanidine (Zanaflex)
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) or naproxen (Aleve)
- selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft)
- tricyclic antidepressants, such as amitriptyline or nortriptyline (Pamelor)
If an underlying condition is found, treatment will be based on the best treatment for that condition.
NDPH is a chronic condition, and daily headache unresponsive to treatment can persist for years. This can be very debilitating and make it hard to perform daily activities, like personal hygiene, cleaning, and shopping. Support groups and counseling may help you cope with this chronic pain.
There isn’t a test that can make the diagnosis. Instead, diagnosis is based on the history of how your headaches started and progressed. Having a continuous headache and remembering the details of its sudden onset are the first step in making the diagnosis.
Tests and imaging studies are done for two reasons:
- Before the diagnosis can be made, all underlying conditions that could be causing the headaches must be excluded.
- Some of the underlying conditions, such as a subarachnoid hemorrhage or cerebral venous sinus thrombosis, can be life-threatening and need immediate and appropriate treatment.
Tests that made be used to exclude other causes include:
Your doctor may ask you about the kinds and frequency of over-the-counter and prescription medications you’re taking to see if your headaches might be due to medication overuse.
Ultimately, a combination of a headache pattern consistent with NDPH and the absence of an underlying cause may confirm a diagnosis of NDPH.
NDPH is a type of chronic headache. Its key feature is you can clearly remember the circumstances of when it started. Symptoms resemble those of migraine or tension headache.
Although it’s often unresponsive to treatment, there are a number of medications to try. Support groups and counseling can help you cope with the effects of continuous headache.