New Daily
Persistent Headache
New daily persistent headache (NDPH) is a rare type of chronic headache characterized by a sudden and acute onset of continuous headache, and the time is typically remembered.
It can have elements of both tension and migraine headaches.
There are two subtypes of NDPH: self-limiting, which resolves itself within months without medical intervention, and constant, which persists despite aggressive treatment.
1
NDPH has a definite memorable beginning.
2
The headache in NDPH is constant.
3
NDPH headaches can be triggered by a stressful life event.
Occurrence
NDPH is a subset of chronic daily headache (CDH). Of the 4% who have CDH, 0.9-35% of children/adolescents and 2.5-10.8% of adults suffer from NDPH. In Norway, the prevalence of NDPH is approx. 0,03%.
Symptoms
The headache in NDPH is constant and can vary in intensity. Symptoms may include pain that can be throbbing, pulsating or pressing. It can be localized in the forehead, temples, back of the head or throughout the head. Some people with NDPH experience migraine-like symptoms such as nausea, light sensitivity and sound sensitivity. Other symptoms such as emotional disturbances, muscle pain, sleep problems and depression may also occur.
Mechanisms
The exact causes of NDPH are unclear, but it is thought to involve a combination of genetic and environmental factors. Primary NDPH can have an onset after a stressful life event. Secondary NDPH usually stems from a viral or bacterial infection.
Duration
The headache in NDPH is constant and lasts for more than three months.
Frequency
The headache in NDPH is constant and occurs daily.
Triggers
Triggers for NDPH can include stressful life events, viral or bacterial infections, surgeries requiring intubation, and Valsalva maneuvers (increasing abdominal pressure).
How to get diagnosed
The diagnosis of NDPH is made based on a thorough medical assessment, including the patient's history, physical examination, neurological examination, and imaging.
Treatment
The treatment of NDPH depends on the symptoms and possible triggering causes.
People with NDPH with migraine symptoms may respond well to prophylactic migraine treatment.
Depending on the symptoms, other medications such as triptans, antidepressants, or botox injections may be helpful.
Manual therapy and exercises can be helpful in relieving pain and tension in the muscles and neck.
Prevention
There is no surefire way to prevent NDPH, but managing stress and avoiding known triggers can help reduce the risk of an outbreak.
Diagnostic Criteria from ICHD-3:
- Persistent headaches that meet criteria B and C.
- Distinct and clearly memorable onset, with pain becoming continuous within 24 hours.
- Present in >3 months.
- Not better accounted for by another ICHD-3 diagnosis.
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