New daily persistent headache (NDPH) is another type of primary chronic headache disorder. The symptoms start very suddenly and remain moderate-to-severe 24/7/365. NDPH generally only affects your head. However, when it comes with migraine-like features, you may experience light sensitivity, sound sensitivity, vertigo, nausea, and/or vomiting. The pain may occur only on one side of the head, both sides, or move between one side and the other.
Because the symptoms last for months or years, NDPH can greatly impact your daily life. And, unfortunately, most cases also prove difficult to treat.
NDPH has two main forms:
- Primary NDPH: “idiopathic” NDPH, meaning there’s no identifiable cause
Secondary NDPH: happens in connection with or because of another condition or disease, usually a viral illness
NDPH can affect anyone, but it’s more common in women and those assigned female at birth. It’s also prevalent in children and teenagers, especially between ages 10-18, but you can still develop it no matter what your age.
There’s been only limited research on how common the disorder is, but the available data indicate it’s not that common. The best available studies come from Norway and Spain, and they suggest it occurs in 30-100 out of every 100,000 people.
Causes of NDPH
As we’ve mentioned, experts don’t know exactly why NDPH happens. However, they suspect stress and viral or bacterial infections may play a part in the process. People who develop NDPH often report going through stressful life events before the pain hit. People also report developing NDPH after medical events like having an infection, but there aren’t enough data to confirm if these events either cause or contribute to NDPH or if they’re just in the wrong place at the wrong time.
What data do exist show that people often develop NDPH while they have either a viral or bacterial infection, including:
- Epstein-Barr virus (a key cause of mononucleosis)
Salmonella
E. coli
Dengue fever
COVID-19
Meningitis or encephalitis
NDPH can also emerge as a secondary effect of another medical condition that directly affects your brain or central nervous system. Examples include:
- Subarachnoid hemorrhage (bleeding into the subarachnoid space; often begins suddenly with a “thunderclap headache”)
Low cerebrospinal fluid (CSF) pressure, usually from a CSF leak
High CSF pressure that causes a headache
Post-injury headache (concussion or traumatic brain injury)
Medication overuse headache (especially for treating headaches or migraine attacks)
Symptoms of NDPH
NDPH symptoms aren’t much different from the other primary headache types, but some happen in an unusual way.
- They’re long lasting: to diagnose, you have to have the headache for at least three months
The pain is constant: nonstop pain once it starts
The pain is usually moderate-to-severe: potential to severely disrupt a person’s life and activities
There’s another symptom, but it’s unique to this headache disorder in particular — you remember exactly when the pain started. According to the International Headache Society’s official guidelines, the International Classification of Headache Disorders, a doctor can only diagnose you with NDPH if you can remember exactly when the headache started, including where you were and what you were doing.
Headaches that occur with NDPH can appear just like standard tension-type headaches (TTHs), migraine, or it may have features of both. TTH symptoms can include:
- Pain on both sides of your head
Pain feels like pressure or a vise around your head
Pain doesn’t get worse depending on what you’re doing
Migraine symptoms can include:
- Pain on one side of your head
Pain that throbs, pulses, or pounds - Sensitivity to light, sound, and smells
Nausea and vomiting
Vertigo
Visual auras - Pain that worsens with activity
Of course, no two attacks are identical, so which symptoms you get, or how many, depend on your individual physiology and circumstances.
Diagnosing and treating NDPH
No tests currently exist to directly diagnose NDPH. Instead, diagnosis focuses on ruling out other medical conditions that could cause similar symptoms, especially dangerous or life-threatening ones. Common tests include:
- Computerized tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Lumbar puncture (spinal tap)
Blood tests to look for signs of infection
Depending on your health history and the symptoms you present with, doctors may also recommend additional tests to rule out other conditions.
Once you’ve been diagnosed, you hit another bump in the road, as NDPH can be difficult to treat. Cases with migraine-like symptoms are usually easier than those with TTH symptoms, which are more likely to be treatment-resistant. Time, too, plays a role. NDPH is more likely to respond more effectively to treatment when you get to it early in its progression rather than years after symptoms begin.
Medications are usually the primary means to treat NDPH. However, finding a medication that’s right for you and can relieve the symptoms is often difficult. Some possible medications include:
- Antidepressants: amitriptyline, nortriptyline, and venlafaxine, which also treat pain disorders, can sometimes help
Antiseizure medications: gabapentin or topiramate
Botulinum toxin injections (brand name Botox®): blocks nerve signals, including pain signals
Migraine preventive medications: include beta-blockers like propranolol and angiotensin-II receptor blockers like candesartan
Experimental anesthetic/antidepressants: ketamine, an anesthetic also used for treatment-resistant depression, may help
All of these medications come with side effects or complications, so make sure you understand why your doctor recommends any one in particular to treat you. You may need to play around with the dose to find a level that suits your specific needs while minimizing adverse effects.
You can find more information about this type of headache on the American Migraine Foundation website.
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