New daily persistent headache (NDPH) causes characteristic periods of persistent headache pain and other symptoms. Primary headache disorder is very rare, meaning that it occurs independently of other health problems, NDPH can resemble other types of headache, such as chronic migraine or tension headache, among others. The onset is sudden, and people with this condition can tell when they started experiencing it.
The exact cause of new, persistent daily headaches is unknown, although they often occur with some infections, including Epstein-Barr virus (EBV) among others. Diagnosis may include blood work, imaging, spinal tap or other tests to rule out other causes of symptoms. Treatment approaches vary and depend on whether the symptoms are migraine-like or tension headaches.
Read on to learn more about NDPH, how it is identified and treated, as well as how to treat this condition.
New and persistent headache symptoms daily
What makes new persistent daily headaches difficult to diagnose is that their symptoms can resemble other types of primary headache disorders, particularly migraines, medication overuse headaches (also known as rebound headaches), and tension headaches. When similar to a migraine, NPHD causes:
Severe headache or tingling, sometimes on one side of the head
Vomiting and nausea
Initial flu-like symptoms
Sensitivity to light, sound, smells, or other stimuli
Symptoms exacerbated by physical activity
The severity of this condition varies from person to person, with some experiencing milder tension headaches. These cases often present with non-pulsating or uninterrupted pain on both sides of the head.
Notably, several features distinguish NDPH from other headache types and help to define the condition clinically. These include:
definite start:Most patients can identify a specific date when the headache began – there is no gradual build-up or warning.
No history of headache: NDPH symptoms appear in the absence of any previous history of similar problems and apart from other health conditions.
constant painThe pain and other symptoms persist on a daily basis for three months or more without stopping.
The exact causes of new, persistent daily headaches are unknown. However, research indicates that they occur due to an inflammatory response triggered by the release of cytokines. These are proteins secreted by certain immune cells that affect other cells. Excess levels of cytokines and other inflammatory markers have been reported in NDPH cases.
This inflammatory response may be why some viral and bacterial infections are associated with a significant portion — though not all — of cases. These include infections with:
The population most at risk
Stressful events can sometimes lead to NDPH, and although all people can have it, women are three times more likely than men to experience the condition. Nearly half of people with this type of headache have close relatives with it, suggesting there is a genetic component as well.
Diagnosis of the new daily persistent headache
As with other primary headache disorders, excluding other causes of the symptoms is often the most important aspect of the diagnosis. Besides chronic migraines or chronic tension headaches, new persistent daily headaches can resemble many other conditions due to their very rapid onset. These potentially very dangerous conditions include:
To rule out these conditions as a cause of persistent headaches, several types of tests may be done:
Symptom assessment:Your primary care providers and/or headache specialists will evaluate your medical history, evaluate your symptoms, and ask about medications you’re taking and any other health factors that may play a role.
blood test:Blood sample tests can tell health care professionals if there is bleeding or blood clots to rule out a brain hemorrhage or a cerebrospinal fluid leak. Furthermore, they can help detect liver or kidney problems, among others.
photography techniques:Several types of imaging may be used to further examine the brain and head. Computerized tomography (CT) scans (three-dimensional images produced using multiple X-rays) and magnetic resonance imaging (MRI) scans of the brain and surrounding veins (called MRVs) and arteries (MRAs) help doctors rule out other causes of sudden headaches.
Spinal tap:In some cases, doctors may need to measure the level of cerebrospinal fluid (CSF). This is done by puncturing the lower spine (lumbar spine) using a small needle to withdraw a small sample for laboratory evaluation.
sedimentation rate:In this test, the rate at which red blood cells settle into the test tube is measured. If this takes longer, this is a sign of an inflammatory response in the body, which can indicate NDPH among other issues.
treatment or treatment
The challenge with new, persistent daily headaches is that there is no single treatment approach. Management is often multifaceted, and because symptoms are persistent, medications used for other headache types may not be effective. Overuse of such medications can lead to medication overuse headaches, which actually exacerbate the pain.
Notably, the course of treatment can also vary based on whether the disorder is migraine-like or tension-type headache-like. In general, NDPH is treated in a range of ways, with patients receiving help from headache and pain specialists.
Several types of medications prescribed for NDPH are also used to treat migraine headaches. Among them:
Also used for chronic migraine headaches, botulinum toxin A injections (Botox injections) into certain parts of the temple, head and neck for permanent pain relief. This treatment can be very effective, although sessions will need to be repeated (every three months or so).
Avoid overuse of medication
Medications for direct pain control, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, should be used sparingly. MoH can arise, as well as dependence on certain medications. Tell your doctor if you take anything for pain relief more than twice a week.
Biofeedback and relaxation techniques
Because stress is closely related to headaches and headache severity, other approaches focus on relieving stress and promoting relaxation. Biofeedback devices measure physical signs of stress and fatigue to inform users when these symptoms are on the rise and to prevent them. Breathing exercises and meditation can also help treat chronic pain.
Making sure you get good and consistent sleep, getting regular exercise, and eating a healthy, balanced diet can also help manage NDPH. These types of changes are often recommended along with other medications or treatments. They have been shown to help with a wide range of chronic pain and headache problems.
Because the symptoms of a new persistent daily headache are ongoing, this condition can be very debilitating. Clinically, cases are divided into those that eventually resolve, usually within 24 months, and those that are refractory to treatment. Research indicates that patients experience NDPH for an average of 3.3 years. However, many get it for five or even 10 or more.
Although there is no one-size-fits-all solution to this condition, consistent treatment with medication and lifestyle modifications allows many people to manage new, persistent daily headaches and live well. Most see a definitive improvement in their symptoms.
Dealing with a new constant daily headache
There is no denying that living with chronic pain can have a very devastating effect on mental health. As with chronic migraines (defined as 14 or more headache attacks per month), people with new persistent daily headaches have higher rates of anxiety, depression, and somatic symptom disorder (a condition that causes physical symptoms in response to stress). It is worth noting that the relationship between mental and physical health is twofold, as one can affect the other.
Living with this condition means not only managing headaches but also dealing with these related issues. Several strategies can help:
stress management: Getting enough sleep, exercising regularly, and eating well are ways you can handle stress. Since stress and headaches are closely related, preventing stress can help manage headaches.
stay connected: Another way to reduce the burden of chronic headaches is to find ways to stay socially engaged and find activities that give you satisfaction. Taking up hobbies, getting more involved in your community, and focusing on relationships with family and friends can help keep you from focusing on your condition.
Consider professional helpSessions with a mental health professional such as a psychiatrist or psychologist can help you overcome the burden of NDPH and develop strategies for coping with the emotional impact of coping with pain.
Ask for supportAs much as friends and family can help you, you may also benefit from connecting with others living with NDPH or other chronic pain conditions. Your doctor or therapist may be able to recommend it online, including on social media, or in-person support groups and advocacy organizations. Reminding you that there are others with experiences like yours who can provide emotional and practical support.
New persistent daily headache (NDPH) is a rare disorder characterized by persistent head pain for three months or more. Symptoms range from mild tension headaches to those of a migraine, which include sharp, throbbing head pain, nausea, light-headedness, and sensitivity.
Diagnosis may include imaging and blood tests, with treatment approaches varying from case to case. Tricyclic antidepressants and antiepileptics are among the types of medications prescribed, with lifestyle modifications and relaxation techniques complementing treatment for this potentially debilitating condition.
Word from Verywell
There is no doubt that new persistent daily headaches are a challenge. By its nature, it arises without warning, the pain is lingering, and there is no specific treatment for it. However, with medical management – as well as with the help of family, friends, and the wider community – the symptoms and burden of this condition can be alleviated.
Our understanding of this and other primary headache disorders continues to grow. Therapies and treatments for NDPH will continue to improve with time and research. Not only is help already available, but more is on the way.