New Daily Persistent Headache (NDPH)

New Daily Persistent Headache (NDPH)

New daily persistent headache is a relatively new clinical entity.  It was first described in 1986.  It is not as prevalent as migraine headaches and occurs more commonly in younger individuals, although it may affect patients at different ages.  The unique and striking feature of new daily persistent headache is it’s abrupt and sudden onset, frequently without any precipitating factors and the fact that the headache becomes chronic and daily from the very beginning (hence the term new daily persistent headache).

What is causing NDPH?

Considering that this is a relatively new and rare clinical entity the cause of NDPH remains unknown.  Some studies have suggested an association with viral illnesses and stress.

How does NDPH present?

New daily persistent headache typically occurs spontaneously, frequently without any obvious precipitating factors.  The pain becomes chronic and daily from the very beginning and many patients can pinpoint a specific date when the headache occurred for the first time.  The pain itself frequently presents with a mixture of symptoms seen in migraine and tension-type headaches.  Headache may occur in the forehead or occipital region, usually on both sides.  The pain can be throbbing or aching and can be associated with sensitivity to light, noise, and occasionally nausea.  The severity of the pain may fluctuate day-to-day.

How is NDPH diagnosed?

New daily persistent headache is a diagnosis of exclusion.  Thorough history analysis and physical examination should be performed.  It may be necessary to perform certain blood tests and obtain an MRI of the brain to rule out other conditions that may present with sudden onset of daily headaches.

How is NDPH treated?

We typically utilize an approach similar to migraine treatment.  We strongly recommend using a combination of prophylactic and acute medications.  Some patients may benefit from interventional approaches including sphenopalatine ganglion blocks (SPG block), occipital and supraorbital nerve blocks, trigger point injections, etc.