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New Daily Persistent Headache (NDPH)

New Daily Persistent Headache:

What is NDPH?

New Daily Persistent Headache or NDPH is a primary headache disorder that begins out of the blue, stays and nothing seems to make it go away. The sufferer will almost always remember the day it began and no cause is generally found when medical advice is sought.

The following information comes from the American Headache Society’s Migraine Toolbox written by Dr. Deborah Tepper MD https://americanheadachesociety.org/wp-content/uploads/2018/05/Tepper-2016-Headache NDPH.pdf

Now for the Science Part

Here’s the Diagnostic Classification according to the International Headache Society…

4.10 New daily persistent headache (NDPH)

Previously used terms:

Chronic headache with acute onset; de novo chronic headache.

Description:

Persistent headache, daily from its onset, which is clearly remembered. The pain lacks characteristic features, and may be migraine-like or tension-type-like, or have elements of both.

Diagnostic criteria:

Persistent headache fulfilling criteria B and C

Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24 hours

Present for >3 months

Not better accounted for by another ICHD-3

  • Bilateral location
  • Pressing/tightening (non-pulsating) quality
  • Mild or moderate intensity
  • Not aggravated by routine physical activity such as walking or climbing stairs

Notes:

New daily persistent headache is unique in that headache is daily from onset, and very soon unremitting, typically occurring in individuals without a prior headache history. Patients with this disorder invariably recall and can accurately describe such an onset; if they cannot do so, another diagnosis should be made. Nevertheless, patients with prior headache (1. Migraine or 2. Tension-type headache) are not excluded from this diagnosis, but they should not describe increasing headache frequency prior to its onset. Similarly, patients with prior headache should not describe exacerbation associated with or followed by medication overuse.

People who suffer from NDPH generally have no history of headache of any kind but they do tend to have a close relative with a frequent headache disorder such as Migraine. About half of those with NDPH have accompanying migraine symptoms such as photosensitivity, nausea, etc.

NDPH can occur at any age from childhood on, even into the 70s. The average age of onset is about 35. It is two to three times more common in women than men.

What triggers NDPH if Anything?

NDPH is not like migraine where it’s often possible to pinpoint a particular trigger like a food trigger, hormonal trigger or even stress. It can be triggered or at least preceded by a bad head cold; however it’s very difficult to look at one particular thing.

How do you find triggers if it’s constant?

Well you can’t really, but what you can do is try to map the patterns in the severity and different accompanying symptoms from day-to-day. This can not only help to pin-point when you might be in danger of your symptoms worsening or when your safer periods might be, but can also show medical professionals how effective or ineffective your treatment is.

How do you treat it?

Medication may not respond but to meet the criteria for Botox and CGRP medication you need to have tried and failed several other treatments so this may be why you’re still on medications that are not working for you.

Neither Botox nor the new anti-CGRP medications are guaranteed to bring relief, but they would be more likely to if they were used in conjunction with a healthy lifestyle, light exercise, a good diet, regular sleep, relaxation therapies, magnesium and/or other supplements.

Medication used to treat NDPH includes;

  • Propranolol
  • Candesartan
  • Amitriptyline
  • Nortriptyline
  • Venlafaxine
  • Topiramate
  • DHE Infusion

What’s the prognosis?

There are two types of NDPH, the kind that goes away, and another sort that remains ongoing with or without treatment for a longer period of time, without a predictable end. Some evaluations suggest that most people with NDPH will be headache free in 3 years, although most maintain that in many the headaches do persist indefinitely, but possibly not as often.

 

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