New Daily Persistent Headache (NDPH) is a type of headache disorder where patients suddenly develop a headache that persists over an extended period of time. While the intensity of the pain may wax and wane, the patient experiences at least one headache a day. Two different forms are recognized, one that tends to resolve on its own after several months and another that may persist for years despite treatment. Management options for new daily persistent headache can depend on how well the patient responds to treatment.
Patients with this condition can typically pinpoint the day it started with a high degree of accuracy. Usually, they don’t have an extensive history of headaches, but experience a sudden onset of intense head pain that does not go away. It lasts for more than two months. Activity usually doesn’t make it worse, and patients may not be any more light or sound sensitive than usual. Treatments like aspirin may not be effective in reducing the pain.
Several conditions can look like new daily persistent headache, including cerebral venous thrombosis and a spontaneous cerebrospinal fluid leak. These conditions can be dangerous if not identified and treated. To avoid a mistaken diagnosis, a doctor may request a full neurological workup for a patient with a case of suspected new daily persistent headache. This can include medical imaging studies to look at the brain, allowing the doctor to identify signs of one of these conditions.
This is an example of a primary headache disorder, appearing without any known cause. Some patients experience flu-like symptoms or fatigue before the new daily persistent headache appears, and others link it with stress or cranial surgery. Treatment needs to focus on pain management and controlling the headache itself. This can include analgesics as well as medications to control blood pressure. Sometimes medications may be used off-label to treat the headache, in which case the patient could receive a drug designed to treat spasms or other issues in the hopes it provides some relief.
Some patients with new daily persistent headache respond well to treatment. Others may find treatment less effective or may need to switch between medications and treatment options to find the ones that are most effective. In cases of refractory headache, nothing works. Headaches of this nature can be frustrating and may cause mental health complications. For this reason, patients may be advised to work with a counselor to manage feelings of depression, anger, or frustration that may arise in treatment.
