What Is New Daily Persistent Headache?

New daily persistent headache (NDPH) causes distinct periods of continuing headache pain and other symptoms. A very rare primary headache disorder, meaning it occurs independently of other health issues, NDPH can resemble other types of headache, such as chronic migraine or tension headache, among others. Onset is sudden, and people with this condition are generally able to pinpoint when they began experiencing it.

The exact cause of new daily persistent headaches is unknown, though they often occur along with certain infections, including Epstein Barr virus (EBV) among others. Diagnosis may involve blood work, imaging, spinal tap, or other tests to rule out other causes of symptoms. Treatment approaches vary and depend on whether symptoms are more like a migraine or tension headache.

Read on to learn more about NDPH, how it’s identified and treated, as well as what it’s like to cope with this condition.

New Daily Persistent Headache Symptoms

What makes new daily persistent headache difficult to diagnose is that its symptoms can resemble other types of primary headache disorders, especially migraine, medication overuse headache (also known as rebound headache), and tension headaches. When resembling migraine, NPHD causes:

• Severe or stabbing headache, sometimes on one side of the head
• Nausea and vomiting
• Flu-like symptoms at initial onset
• Sensitivity to light, sound, smells, or other stimuli
• Worsening symptoms due to physical activity

The severity of this condition ranges from person to person, with some only experiencing milder, tension headaches. These cases often exhibit non-throbbing or -pounding head pain on both sides of the head.

Notably, several features distinguish NDPH from other headaches and help clinically define the condition. These include:

• Specific onset: Most patients can identify a specific date that the headaches began—there’s no gradual buildup or warning.
• Lack of headache history: NDPH symptoms arise in absence of any previous history of similar problems and independently of other health conditions.
• Continuous pain: The pain and other symptoms persist daily and continuously for three or more months without remitting.

Causes

The exact causes of new daily persistent headaches are unknown. However, research suggests they occur due to an inflammatory response caused by the release of cytokines. These are proteins that are released by certain immune cells that affect other cells. Excess levels of cytokines and other signs of inflammation have been recorded in NDPH cases.

This inflammatory response may be the reason why certain viral and bacterial infections are associated with a significant portion of—though not all—cases. These include infections with:

• Epstein-Barr virus
• Herpes simplex virus
• Herpes zoster virus
• Toxoplasmosis
• Salmonella
• Streptococcus

Diagnosing New Daily Persistent Headache

As with other primary headache disorders, ruling out other causes of symptoms is often the most important aspect of diagnosis. Along with chronic migraine or chronic tension headache, new daily persistent headache can resemble several other conditions because of its very rapid onset. These potentially very dangerous conditions include:

• Brain hemorrhage (bleeding in the brain)
• Cerebrospinal fluid (CSF) leak (leak of fluids surrounding the brain and spinal cord)
• Cancer
• Untreated sinus infection
• Very high blood pressure  
• Other infections

To rule out these conditions as the cause of the persistent headaches, several types of tests may be performed:

• Evaluation of symptoms: Primary care providers and/or headache specialists will evaluate your medical history, assess your symptoms, ask about medications you’re taking and any other health factors that may be at play.
• Blood testing: Tests of blood samples can tell healthcare professionals if there’s bleeding or blood clots present to rule out brain hemorrhage or CSF leaks. Further, they can help detect liver or kidney problems, as well as other issues.
• Imaging techniques: Several kinds of imaging may be used to further screen the brain and head. Computerized tomography (CT) scans (3D images produced used multiple X-rays) and magnetic resonance imaging (MRI) of the brain and surrounding veins (called MRVs) and arteries (MRAs) helps clinicians rule out other causes of sudden headache.
• Spinal tap: In some cases, doctors may need to measure cerebrospinal fluid (CSF) level. This is done by puncturing the lower spine (lumbar spine) using a small needle to draw a small sample for laboratory assessment.        
• Erythrocyte sedimentation rate: In this test, the rate at which red blood cells (erythrocytes) settle in a test tube is measured. If this takes a longer time, it’s a sign of an inflammatory response in the body, which can indicate NDPH among other issues. 

Treatment

The challenge with new daily persistent headaches is that there’s no single treatment approach. Management is often multifaceted, and—because the symptoms are continuous—medications used for other headache types may not be effective. The use of too much such medicine can lead to cases of medication overuse headache (MOH), which actually causes the pain to worsen.

Notably, the course of treatment can also vary based on whether the disorder is more like a migraine or more like a tension headache. Generally, NDPH is treated with a combination of methods, with patients getting help from headache and pain specialists.

Preventative Medications

Several kinds of drugs prescribed for NDPH are also used to treat migraines. Among these are:

• High blood pressure medications, particularly Inderal (propranolol) or Atacand (candesartan)
• Tricyclic antidepressants, including amitriptyline, Pamelor (nortriptyline), or Effexor (venlafaxine)
• Antiepileptic drugs, especially Topamax (topiramate)

Also used in chronic migraine cases, injections of botulinum toxin A (Botox injection) in certain parts of the temples, head, and neck and provide lasting pain relief. This therapy can be very effective, although repeat sessions (every three or so months) are necessary.

Biofeedback and Relaxation Techniques

Since stress is closely associated with headaches and headache severity, other approaches focus on easing stress and promoting relaxation. Biofeedback devices measure physical signs of tension and strain to let users know when these symptoms are on the rise and prevent them. Breathing exercises and meditation can also help with chronic pain.

Lifestyle Changes

Ensuring that you get good and consistent sleep, get regular exercise, and eat a healthy and balanced diet can also help manage NDPH. These types of changes are frequently recommended alongside medications or other therapies. They’ve been shown to help with a wide range of chronic pain and headache problems.

Prognosis

Because the symptoms of new daily persistent headaches are continuous, this condition can be very debilitating. Clinically, cases are divided into those that eventually resolve, usually within 24 months, and those that are refractory, or resistant to treatment. Research suggests that patients experience NDPH for an average of 3.3 years. However, many have it for five or even 10 or more.

While there is not a one-size-fits-all fix for this condition, consistent treatment with medications and lifestyle adjustments lets many people manage and live well with new daily persistent headaches. Most see eventual improvement of their symptoms.

Coping With New Daily Persistent Headache

There’s no denying that living with chronic pain can have a very debilitating impact on mental health. As with chronic migraines (defined as 14 or more headache attacks per month), those with new persistent daily headache have higher rates of anxiety, depression, and somatic symptom disorder (a condition that causes physical symptoms in response to psychological stress). Notably, the relationship between psychological and physical health is two-sided in which one can impact the other.  

Living with this condition means not only managing the headaches but also taking on these related issues. Several strategies can help:

• Stress management: Getting enough sleep, regular exercise, and eating well are ways you can address stress. Since stress and headache are closely related, and preventing stress can help manage headaches.
• Stay engaged: Another way to minimize the burden of chronic headaches is to find ways to stay socially engaged and find activities that give you satisfaction. Taking up hobbies, getting more involved in your community, and focusing on relationships with family and friends can all help prevent you from focusing on your condition.
• Consider professional help: Sessions with a mental health professional such as a psychiatrist or psychologist can help you cope with the burden of NDPH and develop strategies for taking on the emotional impact of living with pain.   
• Seek support: As much as friends and family can help, you may also benefit from connecting with others who are living with NDPH or other chronic pain conditions. Your doctor or therapist may be able to recommend online, including social media, or in-person support groups and advocacy organizations. Reminding you that there are others who have experiences like yours can offer emotional and practical support.

Summary

New daily persistent headache (NDPH) is a rare disorder characterized by continuous head pain for three or more months. The symptoms range from milder tension headaches to migraine symptoms, which include very sharp, throbbing head pain, nausea, and light and sensitivity.

Diagnosis may involve imaging and blood tests, with treatment approaches varying from case to case. Antiepileptic and tricyclic antidepressants are among the types of medications prescribed, with lifestyle modifications and relaxation techniques rounding out therapy for this potentially debilitating condition.  

A Word From Verywell

There’s no doubt that new daily persistent headache is challenging. By nature, it arises without warning, the pain lingers, and there’s no set treatment for it. That said, with medical management—as well as the aid of family, friends, and the broader community—the symptoms and burden of this condition can be eased.

Our understanding of this and other primary headache disorders is still growing. Treatments and therapies for NDPH will continue to improve with time and research. Not only is help already there for you, but more is on the way.