What is New Daily Persistent Headache?

What is New Daily Persistent Headache?

When seeing a primary care doctor for unrelenting daily head pain, the term New Daily Persistent Headache may never even come up. The term rarely, if ever, appears in internet search results when researching your symptoms. More often you may be confronted with a host of other alarming (and often unlikely) conditions. The unfortunate reality is that information on less understood diagnoses like New Daily Persistent Headache (NDPH) is limited and unnecessarily bleak, leaving many people undiagnosed or misdiagnosed. 

Let’s take a good look at this disorder, how it differs from migraine and why there is reason to be hopeful.  

Making the Diagnosis of New Daily Persistent Headache

A NDPH diagnosis is made after analyzing a person’s detailed medical history. Healthcare providers typically order tests to rule-out other possible causes for daily, non-stop headaches, but an experienced neurologist, especially a headache specialist, will zero-in on some key criteria.

Unlike many other diagnoses, the name NDPH is very descriptive.

“N, new” – The headache begins seemingly out of nowhere. The diagnosis does not apply to someone who experienced frequent headaches before. The headache did not build-up over time nor can it be described as intermittent and suddenly worse.

“D, daily” – The pain is there each day without exception.

“P, persistent”– The head pain is always there (except when sleeping) although the intensity may vary. To meet the official criteria, the headache must persist for at least 3 months.

“H, headache”– The person’s main complaint is head pain that is usually described as mild to moderate “tightness” or pressing pain. There may be other symptoms that are frequently reported with migraine attacks like nausea and light or sound sensitivity, but the main complaint is the never-ending head pain.

Much of the clinician’s inquiry will center around the type of head pain, other physical symptoms and most importantly, whether or not the patient can pinpoint the day that it all started. The doctor will also ask about other potentially significant factors that were happening at the time you first noticed the persistent headache. The reason for this is that about half of people with NDPH can recall a viral illness, a very stressful event or a surgical procedure that occurred right before the headache started.¹

NDPH is a primary headache disorder, meaning it’s not due to another health condition. It’s also the only headache disorder in which people can typically be specific about the day it all started.

The official criteria for NPDH is as follows:²

1. Persistent headache fulfilling criteria B and C
2. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours
3. Present for >3 months
4. Not better accounted for by another disorder

Similarities Between NDPH and Migraine

It can sometimes be difficult to differentiate between migraine and NDPH as they can seem similar on the surface. Some of those similarities are shared symptoms like light and sound sensitivity, although not everyone experiences these symptoms. Additionally, nausea is common in both disorders.

The list of treatment options for both conditions is also similar. Experienced neurologists will offer treatment plans based on the way the symptoms are described to bring about the best chance of relief. For instance, if pain tends to be focused in certain areas of the head and neck, whether the person has a diagnosis of NDPH or migraine, the prescribed treatment may be certain nerve blocks for acute intervention.

To help break the cycle or minimize the intensity of the pain, the doctor may choose from a variety of different medications that have been proven effective for both primary headache disorders in his/her practice. For example, amitriptyline is a common preventive medication used for NDPH and migraine. OnabotulinumtoxinA (Botox) has also been shown to be effective in both diagnoses for prevention.³

Like migraine, NDPH is poorly understood and often takes time to find effective help. Both migraine and NDPH patients tend to spend a great deal of time and money on home remedies, seeing multiple doctors and getting many tests that come back “normal” when they constantly feel abnormal.

How is NDPH Different From Migraine?

While the main symptom of NDPH is headache, migraine is more often described as head pain accompanied by other bothersome symptoms that can range from nasal congestion to debilitating dizziness or vomiting.

The underlying causes of the diseases are different. Migraine is thought to be genetic as many people with migraine know a first-degree relative with the disorder.⁴ Most people with NDPH do not report having relatives with daily head pain and the disease often begins as the result of a stressful situation, surgery or virus.

While both can be debilitating at times, they can be unbearable in different ways. In general, migraine can be physically exhausting but typically lasts hours or days. People with migraine are usually asked to track the days that they experience symptoms as they have days where they are disabled and days that they are well. Contrarily, NDPH takes a terrible mental and emotional toll because the person has no symptom-free days.

Additionally, there are fewer resources because NDPH is considered a rare disorder. The lack of information and support can be even more isolating.  Most people know others with migraine attacks but not with NDPH. 

Finding Individualized Support, Treatment and Hope

The diagnosis of NDPH can fill some with despair especially when the news is delivered by a person who lacks the ability to inspire hope. “Learn to live with it,” is tough to accept. People with NDPH can and do get better.

Seek doctors with expertise in headache disorders that will partner with you to find the best combination of treatments to improve your quality of life. According to certified headache specialist, George Nissan, D.O., 10 people with NDPH will have 10 different treatment plans. The protocols that are usually most effective include medications as well as complimentary therapies like acupuncture, biofeedback and massage.⁶

Finding an effective therapist may be the key to learning coping skills to help with the emotional and mental aspects of living with chronic pain. Accepting NDPH does not mean succumbing to it. A good therapist can help you process the emotional aspect of the diagnosis and develop coping skills to shift the burden of pain into the background of your day to day.

Assembling a team of supportive professionals may take some time. Find your fighting spirit and surround yourself with people who support your wellness efforts. Look for those who are confident that you can and will get better.

References

1. https://pubmed.ncbi.nlm.nih.gov/26474179/
2. https://ichd-3.org/other-primary-headache-disorders/4-10-new-daily-persistent-headache-ndph/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444222/
4. https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-019-1017-9
5. https://americanmigrainefoundation.org/find-a-doctor/
6. https://headaches.org/resources/new-daily-persistent-headaches/

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