Understanding New Daily Persistent Headache (NDPH)

New Daily Persistent Headache (NDPH) is a rare yet debilitating headache disorder that begins suddenly and does not go away. Unlike migraine or tension-type headache, which come and go, NDPH is persistent, often leaving those affected searching for answers and relief. Despite its significant impact, NDPH remains under-researched and challenging to treat.

What is NDPH?

NDPH is classified as a primary headache disorder, meaning it is not caused by another medical condition such as a brain tumor or infection. It is distinct from other headache disorders because:

  • The headache starts on a specific day that the person clearly remembers
  • The pain is daily and continuous from its onset
  • It lasts at least three months with no relief

While some people with NDPH may experience symptoms similar to migraine, such as nausea, light and sound sensitivity, others report dull, tension-like pain.

What Causes NDPH?

The exact cause of NDPH is unknown, but several triggers have been identified, including:

  • Viral infections such as Epstein-Barr virus or COVID-19
  • Surgical procedures or head trauma
  • Concussive events
  • Stressful life events

For some, NDPH appears out of nowhere with no clear trigger. This unpredictability makes it even more frustrating for those affected.

How is NDPH Diagnosed?

Diagnosis is based on clinical history and the exclusion of other possible causes. A doctor may order:

  • MRI or CT scans to rule out structural issues
  • Blood tests to check for infections or autoimmune conditions
  • A detailed headache history to distinguish NDPH from other headache disorders

One key question often used in diagnosis is: “When was the last time you did not have a headache?”
People with NDPH can often pinpoint the exact day their headache started, whereas those with migraine usually have headache-free periods.

Is There a Cure for NDPH?

Currently, there is no single treatment or cure for NDPH. Since the condition is relatively new, first described in 1986, treatment approaches are often adapted from migraine or tension headache management.

Common Treatments Tried for NDPH

  • Medications: Migraine treatments such as CGRP inhibitors, triptans, or antidepressants like amitriptyline and Cymbalta
  • Infusion Therapies: DHE infusions or corticosteroids, which some patients find temporarily helpful
  • Neuromodulation Devices: Cefaly or gammaCore, which use electrical stimulation to relieve pain
  • Lifestyle Adjustments: Stress management, hydration, dietary changes, and physical therapy
  • Alternative Treatments: Some patients explore acupuncture, biofeedback, or, in rare cases, psychedelics for pain relief

Unfortunately, NDPH is often highly refractory, meaning many patients struggle to find effective treatments. Some cases resolve over time, particularly in younger individuals, but others persist for years.

Living with NDPH

Because NDPH is constant and unrelenting, it can take a severe toll on daily life, work, and relationships. People with NDPH often feel overlooked in the headache community, as research funding primarily focuses on migraine.

Support groups and headache specialists familiar with NDPH can provide crucial guidance and connection. While more research is needed, raising awareness of this disorder is an essential step toward better treatments and, ultimately, relief for those living with NDPH

This resource is based on HeadWise Episode 158, NDPH Aware Survey with Alan Kaplan and Mark Burish, MD.
Published 07/07/2023

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