New daily persistent headache (NDPH) does not have a specific treatment, however, certain medication, behavioral therapy and stress management may help patients get better.
New daily persistent headache (NDPH) is a primary headache disorder that presents as a chronic daily headache that is unremitting from the start or from within three days of its onset. The prominent feature of NDPH is that patients often remember the date or circumstance when the headache began.
New daily persistent headache (NDPH) is defined as:
- A new-onset headache that occurs in a person who does not have a previous history of frequent headaches AND
- Which then persists daily for at least more than three months.
NDPH does not have a specific treatment or medicine, but often, nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), behavioral therapy and stress management can help patients get better.
Pathophysiology of new daily persistent headache
A predisposing factor causing new daily persistent headache (NDPH) is believed to be cervical spine joint hypermobility. Hypermobility of the cervical spine joint affects the nerve inputs in the trigeminal nucleus caudalis (TNC), which then results in NDPH. Some patients with NDPH develop it following an infection. Hence, NDPH is a result of persistent inflammation of the nervous system.
Features of NDPH:
- Headaches come on suddenly, usually in people without a headache history, and become constant within three days of the first headache.
- They often affect both sides of the head.
- They cause pain that feels like pressing or tightening but not pulsating.
- They cause mild to moderate pain.
- They might have features of chronic migraine or chronic tension-type headache.
What causes new daily persistent headache?
Common causes of new daily persistent headache (NDPH) include:
- Tightening of the muscles of the head and neck, which can create tension and pain
- Stimulation of the trigeminal nerve, which is the primary nerve supplying the face. Activation of this nerve presents with pain behind the eyes, as well as nose blisters and ocular redness that are associated with some types of headaches.
- Changes or fluctuations in the levels of certain hormones, such as serotonin and estrogen
What are the symptoms of new daily persistent headache?
Common signs and symptoms of new daily persistent headache (NDPH) include:
What is the treatment for new daily persistent headache?
Medications that can be used to prevent or treat persistent headaches include:
- Antidepressants can help prevent headaches, as well as combat anxiety or depression that may occur due to having constant headaches.
- Beta-blockers such as propranolol may help in some cases.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen should be used with caution because overuse can cause rebound headaches.
- Doctors may prescribe anti-seizure medications on a case-by-case basis.
- Botox injection of a neurotoxin derived from bacteria that causes botulism may be an option for patients who are unable to tolerate taking medication every day.
- Behavioral therapy, which can be given either alone or in a group, to manage triggers such as stress or involuntary muscle tightening leading to pain.
- Biofeedback, which uses monitoring devices to understand and learn to control body functions such as blood pressure, heart rate and muscle tension.
- Occipital nerve stimulation, which is a surgical procedure in which the doctor places a small device at the base of the skull that sends electrical impulses to the occipital nerve, which can relieve headache pain in some patients.
- Acupuncture, an alternate medication technique that involves inserting tiny hair-thin needles into specific places on the body.
- Massage, which can help with relaxation and reduce tension in the muscles.
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