What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Daily Headache
• De Novo Chronic Headache
• NDPH (New Daily Persistent Headache)

What is New Daily Persistent Headache? (Definition/Background Information)

• According to the American Migraine Foundation, New Daily Persistent Headache (NDPH) is defined as a primary headache disorder, which is not due to an underlying causative condition
• In order for New Daily Persistent Headache to be characterized so, the headache (pain) should occur on a daily basis, be present for over three months, and should have developed in an individual without a previous history of headaches. It is reported that in many cases, the individuals remember the exact date of NDPH onset, since it is abrupt
• Another condition that needs to be satisfied for New Daily Persistent Headache to be termed so is that if it arises in an individual with a prior history of headache, an increased frequency of headaches should not be noted during the period prior to NDPH onset
• No risk factors are observed for New Daily Persistent Headache; however, the condition is noted to occur against a background of surgery, infection, or stress, in over half the cases. Apart from the headache, individuals may also have nausea, anxiety, and mood issues
• Since the cause of the condition is not known, a symptomatic treatment for New Daily Persistent Headache is provided in most cases that may involve pain medication, physical therapy, and emotional support
• The prognosis of New Daily Persistent Headache varies from one individual to another. In some, the condition resolves by its own; while in others, it can persist for many months and years. Occasionally, the condition may also be non-responsive to active therapy

Who gets New Daily Persistent Headache? (Age and Sex Distribution)

• New Daily Persistent Headaches is a rare condition that is observed in both children and adults in the 6-70 years’ age group (average age of presentation is 35 years)
• Females are more prone to developing the condition than males
• Individuals of all racial and ethnic groups may be affected

What are the Risk Factors for New Daily Persistent Headache? (Predisposing Factors)

There are no well-established risk factors for New Daily Persistent Headaches. However, NDPH may be seen against a background of the following factors/conditions in about 50% of the cases:

• Recent surgery, may be to the head
• Infectious disease; flu-like illnesses
• Stressful events
• Head injury

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of New Daily Persistent Headache? (Etiology)

• Currently, the exact cause of development of New Daily Persistent Headache is not well established
• Some researchers report that NDPH may be due to a viral infection or an immune-mediated condition

What are the Signs and Symptoms of New Daily Persistent Headache?

The common signs and symptoms of New Daily Persistent Headaches include:

• Persistent throbbing headache that is observed daily; it may mimic chronic migraine
• The continuous and steady pain may involve both sides of the head; the headache may vary in intensity from mild to moderate
• The pain may be of a stabbing nature, like the tightening up of muscles, or a dull aching pain
• Some individuals may also have a burning pain
• Individuals may observe increased sensitivity to sound and light
• Mild nausea
• Anxiety and mood swings

How is New Daily Persistent Headache Diagnosed?

A diagnosis of New Daily Persistent Headache is arrived at by a thorough clinical examination, symptom assessment, and exclusion of other conditions that can potentially cause headaches.

The diagnosis may involve the following tests and exams:

• Complete physical examination and assessment of signs and symptoms
• Thorough analysis of personal and family medical history
• Neurological examination by a qualified healthcare provider, if necessary
• Lab tests to rule out other causative conditions
• Imaging tests such as MRI and CT scans (of the head and neck region), when necessary
• Differential diagnosis to rule out other conditions that may manifest with similar signs and symptoms such as:
  • Cerebral venous sinus thrombosis
  • Head injury causing hematoma
  • Meningitis
  • Medication-overuse headache (rebound headache)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of New Daily Persistent Headache?

The complications of New Daily Persistent Headaches may include the following:

• Emotional and mental stress
• Poor performance at school or at work
• Inability to function in regular activities, resulting in decreased quality of life
• Side effects of medications

How is New Daily Persistent Headache Treated?

Presently, the management of New Daily Persistent Headache is focused on decreasing pain and bringing about a measure of relief to the individual, since there is no specific treatment outlined for NDPH. Some of the treatment measures may include:

• Use of pain or antimigraine medication such as triptans and non-steroidal anti-inflammatory drugs (NSAIDs)
• Any combination medication that are normally used for headaches
• Administration of antiseizure medications, muscle relaxants, and antidepressants, based on assessment of the healthcare provider
• Physical therapy and psychological support, as needed
• Newer therapies, such as nerve block procedures, and the use of opiates/narcotics is being researched into

How can New Daily Persistent Headache be Prevented?

Presently, it is not possible to prevent New Daily Persistent Headaches, since their underlying cause is unknown. Nevertheless, the following may be considered to potentially reduce one’s risk for migrainous headaches:

• Undertake prompt treatment of any longstanding headache/migraine, high blood pressure, or even mild head injuries
• Maintain a healthy lifestyle and optimum body weight, which includes ‘no smoking’ (or consumption of other tobacco-based products), keeping blood pressure under check, staying physically fit, controlling cholesterol levels, reducing stress, etc.
• Be careful while driving (always wear a seat belt), while performing any physical tasks/job-related activities, or while exercising with weights - all factors that puts one at risk for a potential traumatic head injury
• Following its onset, regular medical screening at periodic intervals with tests and physical examinations are recommended

What is the Prognosis of New Daily Persistent Headache? (Outcomes/Resolutions)

The prognosis of New Daily Persistent Headaches is difficult to assess.

• In some individuals, the condition is self-limiting and tends to resolve within a few months of onset, even without therapy
• Some individuals are known to have the condition for a long period of time (even many years). In some, the condition may not even respond to aggressive therapy
• According to some reports, in about 15% of the cases NDPH may have a state of remission (symptom-free period); although, in 8% of the cases, the headaches tend to ‘come and go’

Additions and Relevant Useful Information for New Daily Persistent Headache:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/