If you have had daily head pain for a few months, you might have a distinct type of primary headache: new daily persistent headache.

Sometimes confused with chronic headache disorders, new daily persistent headache (NDPH) is unique in one way: NDPH sufferers have no prior history of a chronic headache syndrome before developing this long lasting headache.

Chronic headaches (including NDPH) affect 45 million Americans every year. NDPH itself is relatively rare, but that is all the more reason to educate yourself on this headache disorder.

What is “new daily persistent headache”?

First described in 1986 by Walter Vanast, new daily persistent headache is well named. Each word in NDPH simply describes what it entails:

  • It is new. Head pain started one day, but the sufferer has no prior history of chronic headaches. Often, the sufferer can pinpoint the exact day that NDPH started.
  • It is daily. To be NDPH, head pain needs to occur at least every other day. Usually, though, every day comes with a headache.
  • It is persistent. Daily continuous headache pain is unremitting for at least three months.
  • It is a headache. Sometimes, NDPH mimics the symptoms of a tension-type headache. Other times, NDPH mimics migrainous pain.

These clinical features are the work of the international medical community. The International Classification of Headache Disorders (ICHD) describes NDPH in great detail, published by the International Headache Society.

NDPH must not be confused with other primary and secondary causes of headaches. The key difference is this:

Before the first onset of headache symptoms, the NDPH sufferer had absolutely no history of chronic headaches. The telltale sign is when patients remember the exact date of their first headache.

How long does NDPH last? Three months is the minimum cutoff. You can try preventive treatments before then and headache pain can last much longer than that. But three months is when your healthcare provider will officially be able to diagnose NDPH.

Diagnosing NDPH: How is it different from a normal headache?

When diagnosing new daily persistent headache, a doctor must rule out other chronic daily headaches, which often include: 

  • Chronic tension-type headaches
  • Chronic migraines
  • Medication overuse headache
  • Hemicrania continua

Although the diagnostic criteria were first proposed in 1994 (called the Silberstein-Lipton criteria), the 3rd edition of the International Classification of Headache Disorders (ICHD-3) included these clinical characteristics of NDPH in a 2004 revision:

  1. With no prior history of chronic headaches, a new chronic headache occurs within a 24-hour period. (In other words, there is no build up. The headaches just start one day.)
  2. The headache is persistent, occurring every single day, within the 24 hours of onset.
  3. The onset can be easily remembered. (4 in 5 patients can remember the exact date.)
  4. The headache continues for three or more months.
  5. Other headache types have been ruled out.

These diagnostic criteria should help you and your doctor figure out whether you should receive a diagnosis of NDPH. But a doctor may still need to administer brain magnetic resonance imaging (MRI) or CAT scan.

When should you be concerned about a headache? Three months is the minimum cutoff for NDPH. Once head pain has persisted for three straight months, you may have this primary headache disorder, and you should see your healthcare provider right away.

Symptoms of NDPH

The symptoms of NDPH vary from person to person. Some experience tension headache-like pain while others experience migraine-like pain. These are the common symptoms:

  • Either intense throbbing like a migraine, or tightening like a tension-type headache
  • Photophobia (light sensitivity) and phonophobia (sound sensitivity)
  • Nausea and vomiting
  • 1 in 10 cases is on one side of the head; most are on both sides 
  • More than half of patients experience lightheadedness
  • Mild or moderate intensity

Causes & Risk Factors

Why new daily persistent headache occurs is unclear, but it seems to be related to inflammation and/or cervical spine joint hypermobility.

There are, however, a few known root causes and risk factors for NDPH. Determining which applies to you is important as it allows you and your provider(s) to target the root cause of your pain.

Causes and risk factors of NDPH:

  • Decreased spinal fluid pressure that leads to spinal headache
  • Increased spinal fluid pressure that leads to pseudotumor cerebri
  • Bleeding around the brain
  • Blood clot in the brain (AKA cerebral venous sinus thrombosis)
  • Medication overuse
  • Intracranial hypertension
  • Lumbar puncture, such as an epidural anesthesia or steroid shot
  • Epstein-Barr virus or another flu-like illness
  • Meningitis
  • Surgical procedure
  • Head trauma
  • A stressful life event

According to a 2016 clinic-based study by Dr. Todd Rozen published in Headache, more than 50% of patients cannot identify an NDPH trigger.

How common is NDPH? Actually, NDPH is rare. A landmark study published in Cephalalgia shows that only 0.03% of Norway’s general population experienced NDPH, and that the average age is 35 years old.

NDPH Treatment Options

Does new persistent daily headache ever go away? In some patients, NDPH can be easily treated and never recur. In others, NDPH may recur later in life.

Nevertheless, you need to treat your NDPH. Fortunately, there are some great NDPH treatment options.

1. Upper Cervical Chiropractic Care

Low levels of cerebrospinal fluid (CSF) can cause cervicogenic headaches, but also can cause new daily persistent headaches. Chiropractic care is the number one treatment option for correcting the spinal alignment and normalizing CSF.

Pain from the upper cervical joints can be felt in the head, leading to chronic headaches. Chiropractic care is one of the most common non-medicine treatments for chronic headaches.

Cervical spine joint hypermobility may influence the onset of NDPH. One study found that 11 out of 12 NDPH sufferers were found to have cervical spine joint mobility.

Physical therapy and chiropractic care are your best bet at solving cervical spine joint hypermobility. And chiropractic care should be your first choice to handle abnormal CSF levels and pain in your upper cervical joints.

Live in the Denver, CO area? Denver Upper Cervical Center is at your disposal. We work with patients to determine the root cause of your headaches, so you can get back to living life uninterrupted. Click here to visit our New Patient Center page.

2. Intravenous Methylprednisolone

Intravenous methylprednisolone (IVM, Solu-Medrol) is used to treat arthritis, blood disorders, eye conditions, and even immune system disorders.

In patients who identified an infection at the onset of their NDPH, IVM therapy seems to be very effective after two weeks.

In a 2010 study, nine patients received IVM followed by oral steroids. After two weeks, seven recovered. After six weeks, all nine recovered.

3. Peripheral Nerve Blocks

Peripheral nerve blocks are a type of regional anesthesia. This anesthetic can be injected near an offending bundle of nerves to stop pain signals from a specific part of your body.

Especially in the geriatric community, peripheral nerve blocks seem to be safe and effective methods of treating NDPH.

4. Prescription Drugs for NDPH

Drug therapy seems to be effective in only a quarter of patients. Prescriptions may work for you, but there are more effective treatment options, and with less side effects.

Antiseizure drugs (AKA anticonvulsants or antiepileptics) like valproate, topiramate, or gabapentin are commonly prescribed for NDPH. Antiseizure drugs have been moderately effective in studies, but valproate seems to show the most promise.

Muscle relaxants like baclofen or tizanidine are occasionally used to fight NDPH. Muscle relaxants should only be used short term.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant shown to prevent migraines better than placebo. Unfortunately, only about 50% of people who start SSRI therapy are able to quit due to antidepressant withdrawal. They also come with many major potential side effects, including increased risk of suicide.

Tricyclic antidepressants, such as amitriptyline, are somewhat effective migraine preventers. However, the side effects can scare some off:

  • Weight gain
  • Insomnia
  • Anxiety
  • Blurred vision
  • Dry mouth
  • Constipation
  • Hives, rashes
  • Nausea

Nonsteroidal anti-inflammatory drugs (NSAIDs) are painkillers like aspirin and ibuprofen. But these work well to relieve periodic headaches, not NDPH.

Looking to the Future

New persistent daily headache is a debilitating disorder.

If you now or if you ever experience daily headaches that started from nowhere and persist for months, talk to your healthcare provider about NDPH treatments, such as intravenous methylprednisolone, antidepressants, antiepileptics, or upper cervical chiropractic care.

If you live in the greater Denver area, click here to request an appointment at Denver Upper Cervical Chiropractic. We work with our patients to treat the root causes of headaches. We reserve Fridays for out-of-town patients.

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