New Daily Persistent Headache

What Is NDPH?

New daily persistent headache (NDPH) is a primary headache disorder characterized by sudden onset of a persistent headache that becomes daily and unremitting within 24 hours. Patients can often name the exact day their headache began.¹

Characteristics²

• Daily headache from onset
• Persistent and unremitting
• No prior history of similar headaches
• Can remember exact onset day
• Lasts more than 3 months
• Often triggered by infection or stressful event

Subtypes

• Migraine-like - Features resembling migraine
• Tension-type-like - Features resembling tension headache

Possible Triggers

• Viral illness (often reported)
• Stressful life event
• Surgery
• Flulike illness
• Sometimes no identifiable trigger

Challenge of NDPH³

• Often resistant to treatment
• Two courses: self-limiting or refractory
• Self-limiting may resolve in months
• Refractory can persist for years

Treatment Approaches

• Migraine preventives (if migraine-like)
• Tricyclic antidepressants
• Muscle relaxants
• Nerve blocks
• Botox
• Often trial and error

References

1. Vanast WJ. New daily persistent headaches: definition of a benign syndrome. Headache. 1986;26(6):317.
2. Headache Classification Committee. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Rozen TD. New daily persistent headache: a clinical update. Curr Pain Headache Rep. 2014;18(7):431.