New Daily Persistent Headache (NDPH): Symptoms & Treatment (2023)


What is new daily persistent headache?

New daily persistent headache (NDPH) is a rare chronic headache disorder. The symptoms of the NDPH start very suddenly and are moderate to severe. It’s not a dangerous condition, but the symptoms last for months and can greatly disrupt your life and routine activities. Most cases of this condition are also difficult to treat.

NDPH has two main forms, primary and secondary.

  • Primary NDPH: Healthcare providers and experts often call this “idiopathic” NDPH, meaning experts can’t determine why it’s happening.
  • Secondary NDPH: This is when NDPH happens in connection with or because of another condition or disease, most commonly a viral illness.

Who does new daily persistent headache affect?

NDPH can affect anyone but is more common in women and people assigned female at birth. It also may happen more often in children and teenagers, especially between ages 10 and 18, but it’s still possible at any age.

How common is new daily persistent headache?

There’s limited research on how common NDPH is, but the available data indicates that it’s rare. The best available studies, which are from Norway and Spain, indicate that it happens in 30 to 100 out of every 100,000 people.

How does new daily persistent headache affect my body?

NDPH typically only affects your brain directly. However, when it has migraine-like features, it may cause light sensitivity, sound sensitivity, vertigo, nausea or vomiting.

Symptoms and Causes

What are the symptoms of new daily persistent headache?

NDPH symptoms aren’t unique, but some happen in an unusual way.

  • They’re long lasting. A requirement for diagnosing NDPH is that you have the headache for at least three months.
  • The pain is constant. Most experts define NDPH as having nonstop pain once it starts.
  • You remember when it started. The International Headache Society’s official guidelines, the International Classification of Headache Disorders, requires that you remember when the headache started. That means a healthcare provider will only diagnose NDPH if you can remember exactly when the headache started, including where you were and what you were doing.
  • The pain is usually moderate to severe. People with NDPH usually have moderate pain or worse. Because the pain is also constant, this has the potential to severely disrupt a person’s life and activities.

Headaches that happen with NDPH can look like standard tension headaches, migraines or have features of both. Tension headache symptoms can include:

  • Pain on both sides of your head.
  • Pain feels like pressure or tightening in or around your head.
  • The pain doesn’t get worse depending on what you’re doing.

Migraine features can include:

(Video) New Daily Persistent Headache: Causes, Symptoms, Treatment

  • Pain on one side of your head.
  • Pain that feels like throbbing, pulsing or pounding.
  • Photophobia (sensitivity or pain from light).
  • Phonophobia (sensitivity or pain from sounds).
  • Nausea and vomiting.
  • Vertigo.
  • Visual auras.

What causes new daily persistent headache?

Experts don't know exactly why NDPH happens, but they suspect certain events and circumstances are possible triggers. Going through stressful events is a common feature for people who develop NDPH. People are also likely to develop NDPH after certain medical events, but there’s not enough data to confirm if these events either cause or contribute to NDPH.

One such key type of trigger is having an infection. People often develop NDPH while they have a viral or bacterial infection, including:

  • Epstein-Barr virus (a key cause of mononucleosis, or just “mono”).
  • Salmonella.
  • E. coli.
  • Dengue fever.
  • COVID-19.
  • Meningitis or encephalitis.

You can also have NDPH as a secondary effect of another medical condition that directly affects your brain or central nervous system. Some examples of this include:

  • Subarachnoid hemorrhage (bleeding into the subarachnoid space between your brain and an outer membrane; this often begins very suddenly with a “thunderclap headache”).
  • Low cerebrospinal fluid (CSF) pressure, usually from a CSF leak in your skull or around your spinal cord.
  • High CSF pressure that causes a headache.
  • Post-injury headache (such as from a concussion or traumatic brain injury).
  • Medication overuse (especially for medications that treat headaches or migraines), which can cause “rebound headaches.”

Is new daily persistent headache contagious?

No, NDPH doesn’t spread from one person to another. While NDPH can happen after some infections, having those infections isn’t a guarantee of developing NDPH.

Diagnosis and Tests

How is new daily persistent headache diagnosed?

Diagnosing NDPH is a multistep process.

  • The first step is to gather information about your symptoms, including how long you’ve had the headache, when it started and what you’re feeling from it.
  • The second step is to rule out other causes of the headache.

The first step usually involves a healthcare provider talking to you and asking you questions. They may also do a neurological exam to check for signs of any related problems with your nervous system.

After the first step is complete, the healthcare provider needs to make sure there isn’t another cause for NDPH. That’s key because NDPH shares so many symptoms with other neurological conditions.

Diagnosing before reaching the three-month requirement

It’s common for people to seek medical care before they reach the three-month requirement for having NDPH. In these cases, your provider will go through all the same diagnostic steps but won’t finalize the diagnosis. In these instances, your provider will diagnose you with “probable NDPH.” Once you reach three months with symptoms, they can formally diagnose you with NDPH.

What tests will be done to diagnose new daily persistent headache?

There aren’t any tests that can directly diagnose NDPH. Instead, tests focus on ruling out other conditions that could cause similar symptoms, especially conditions that are dangerous or life-threatening. Some possible tests include:

(Video) What is New Daily Persistent Headache? Chapter 2: Headache Types - Migraine Explainer Video Series

  • Computerized tomography (CT) scan.
  • Magnetic resonance imaging (MRI) scan.
  • Lumbar puncture (spinal tap).
  • Blood testing to look for signs of infection.

Depending on your medical history or the symptoms you describe, your provider may also recommend other tests. You can talk to your provider to learn more about the tests they recommend and the reason for the recommendation. They’re the best source of information relevant to your situation and can tailor the information to your specific circumstances.

Management and Treatment

How is new daily persistent headache treated, and is there a cure?

NDPH is often a difficult condition to treat. Some cases of this condition are easier to treat, especially those with migraine-like symptoms. Tension headache cases are more likely to resist treatment. Time is also a factor, as NDPH is more likely to respond to treatment when treated earlier rather than years after symptoms begin.

Medications are usually the main way to treat NDPH. However, finding a medication that can treat this condition is often difficult. Some examples of possible medication types include:

  • Antidepressants. Medications like amitriptyline, nortriptyline and venlafaxine, which also treat pain disorders, can sometimes help NDPH.
  • Antiseizure medications. Some examples include gabapentin or topiramate.
  • Botulinum toxin injections (commonly known by the brand name Botox®). This drug blocks nerve signals, including pain signals. Other types of nerve blocks can also help.
  • Medications used to prevent migraines. Examples include beta-blockers like propranolol and angiotensin-II receptor blockers like candesartan.
  • Experimental anesthetic/antidepressants. Ketamine, a powerful anesthetic that also sees experimental use in treating resistant depression, can sometimes help NDPH.

Complications or side effects of the treatments

The possible complications and side effects that can happen with the treatments depend on many factors, especially the specific medication. Your healthcare provider can tell you more about the side effects and complications that are most likely for you, and what you can do to prevent them or minimize their effects.

How do I take care of myself or manage the symptoms?

Treating NDPH yourself is difficult, especially when you don’t have a diagnosis. That’s because this condition often won’t respond to standard headache treatments. That means over-the-counter medications, and even many prescription medications, aren’t effective at stopping NDPH.

You also shouldn’t try to self-diagnose or self-treat NDPH because a moderate or severe headache that starts suddenly is also a key symptom of a stroke. Strokes happen because of blood clots or other blockages in your brain, cutting off blood flow. The longer you wait to get medical care after symptoms start, the less likely that the symptoms are reversible. Eventually, a stroke causes permanent brain damage or even death.

If you or someone you’re with has this symptom, especially with other stroke symptoms, you should immediately call 911 (or your local emergency services number).

IMPORTANT: To recognize the symptoms of a stroke, remember to think FAST:

  • F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of paralysis (facial hemiplegia) or muscle weakness.
  • A is for arm: A person having a stroke often has muscle weakness or paralysis on one side. Ask them to raise their arms. If they have new one-sided weakness or paralysis, one arm will stay higher while the other will sag and drop downward, or won’t raise up at all.
  • S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
  • T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider about when the symptoms started can help the provider know what treatment options are best for you.

How soon after treatment will I feel better?

Unfortunately, there’s no way to know whether or not different treatments will work. It’s common for many medications to have no effect on NDPH. In general, it takes about six to eight weeks for a preventive treatment plan to take effect. Your healthcare provider is the best person to talk to you about how fast a medication — if effective — should work. They can tell you what you can and should expect, and what you should do if treatment isn’t effective.

(Video) New Daily Persistent Headache (NDPH): Causes And Symptoms


How can I reduce my risk of developing new daily persistent headache, and is it preventable?

Unfortunately, NDPH happens unpredictably. That means there’s no way to prevent it. Many of the possible triggers also happen unpredictably, so there’s also no way to effectively reduce your risk.

Outlook / Prognosis

What can I expect if I have new daily persistent headache?

If you have NDPH, you should expect a headache with moderate to severe pain. This headache lasts for at least three months, and the pain occurs every day and doesn’t stop. Some people do get relief from treatment, but many don’t.

How long new daily persistent headache lasts

For some people, NDPH is something they’ll experience for years before it eventually goes away. The headache usually stops within three years for people who fall into this category. In others, the headache never goes away. When people have NDPH that doesn’t respond to treatment and doesn’t stop on its own, this condition can be so disruptive that it interferes with their ability to work, participate in social activities and more. Learning to live with this condition also can involve providers from multiple specialties, such as a mental health provider to treat the psychological effects of living with chronic pain.

Outlook for new daily persistent headache

On its own, NDPH isn’t a dangerous condition. However, living with moderate or severe chronic pain is known to affect a person’s mental and emotional well-being negatively. People with chronic pain conditions commonly also develop or have mental health conditions like anxiety and depression.

Multiple factors make this condition difficult to diagnose. These include:

  • This condition is rare.
  • There aren’t any diagnostic tests that can definitively confirm it.
  • Imaging tests usually don’t show any changes that could explain the symptoms.

Because of all the above factors, people with NDPH may need to see multiple healthcare providers before they get a diagnosis. As this is a condition that providers can only truly diagnose after a person has symptoms for at least three months (though they can diagnose it as a probable case before that), people with NDPH often live with the symptoms without a definite answer on what’s causing their condition. That can further contribute to mental health concerns like anxiety and depression.

Living With

How do I take care of myself?

If you have NDPH, a healthcare provider can offer suggestions on what you can do to try to help this condition. For the most part, there’s not much that most people can do to manage this condition. However, there’s some evidence that focusing on your general health and well-being can improve the odds that certain treatments — especially medications — will work. In general, the health behaviors that seem most beneficial include:

(Video) New Daily Persistent Headache (NDPH) Diagnosis | Diagnosis Discussion Series

  • Eat a healthy diet.
  • Get regular physical activity.
  • Have a regular sleep schedule and get enough sleep.

When should I see a healthcare provider?

In general, you should see a healthcare provider if you don’t have a history of headaches and develop a new, moderately painful headache that meets any of the following criteria:

  • It doesn’t get better with over-the-counter medications and/or it gets continually worse.
  • It happens on only one side of your head or involves throbbing, pounding or pulsing pain.
  • You have other symptoms like severe nausea and vomiting, or sensitivity to light and sound.

The above criteria aren’t just signs of NDPH, but can also happen with several other severe headache disorders or health conditions. These usually happen with serious conditions that a healthcare provider should examine to see if you have a concern that needs medical care.

When should I go to ER?

Severe headaches that happen suddenly, don’t get better or worsen over time are also potential signs of severe or dangerous conditions. There are also other symptoms that indicate you need to get medical care immediately. These include:

  • Weakness, numbness or tingling on one or both sides of your body.
  • Loss of vision or disruptions in your vision, like blurred vision, double vision, etc.
  • Confusion or feeling very tired.
  • Trouble with balance or speaking.

Frequently Asked Questions

Is new daily persistent headache different from migraines, cluster headaches or other headache disorders?

Yes, NDPH is different from other headache disorders. NDPH can share some features with migraines and other headache disorders, but is different enough that experts classify it on its own.

Does new daily persistent headache ever go away?

NDPH goes away for some people, but not for all. However, there’s no way to predict when this will happen or to whom.

When should I be concerned about recurring headaches?

You should be concerned about recurring headaches that are moderately painful or worse, or that don’t get better with treatment or go away on their own. If you have headaches every day, it’s a good idea to talk to a primary care provider. While it’s common to have daily headaches for mostly harmless reasons, like needing eyeglasses or contacts, you can also have them for other, more serious reasons.

Is it normal to have a slight headache every day?

No, it’s not normal to have a headache every day. If you have daily headaches, it’s a good idea to talk to a healthcare provider. They can determine if you have a serious condition that’s causing your headaches or if you need to see a specialist for further care. In many cases, a provider can rule out serious conditions and help you find ways to stop headaches from happening or treat them when they do.

A note from Cleveland Clinic

New daily persistent headache (NDPH) is a rare condition where a person develops a new headache that’s moderately painful or worse and doesn’t get better over time. This condition is difficult to treat, and many people with it have pain and other symptoms for years. Sometimes, the headache goes away on its own, but this happens unpredictably. Healthcare providers can suggest treatment options, but more research is necessary before experts can say why this condition happens and what means are most effective in treating it.

(Video) Paul Lima on his New Daily Persistent Headache


What triggers NDPH? ›

common triggers for ndph

In a study published in Headache , possible triggering events were: an infection or viral illness. surgical procedure. stress-causing life events.

Why am I having headaches all day every day? ›

The causes of many chronic daily headaches aren't well-understood. True (primary) chronic daily headaches don't have an identifiable underlying cause. Conditions that might cause nonprimary chronic daily headaches include: Inflammation or other problems with the blood vessels in and around the brain, including stroke.

Is NDPH considered a disability? ›

New daily persistent headache (NDPH) presents with a sudden onset headache which continues without remission within 24 h. Although rare, NDPH is important because it is one of the most treatment refractory primary headache disorders and can be highly disabling to the individuals.

Is NDPH treatable? ›

NDPH does not have known treatment or medicine that cures it. In the previous description of 79 NDPH patients, 10 patients had their headaches go away while taking a preventive medication. Six of these lucky patients had their NDPH go away while on nortriptyline, and 4 of the 10 were taking topiramate.

Can chronic daily headaches be cured? ›

While the condition is frustrating and disabling, it is potentially curable. An extremely difficult to treat — and all too common — type of CDH is a transformed migraine.

When should I worry about daily headaches? ›

See a GP if: your headache keeps coming back. painkillers do not help and your headache gets worse. you have a bad throbbing pain at the front or side of your head – it could be a migraine or, more rarely, a cluster headache.

Should I be worried if I get headaches everyday? ›

Consult with your primary care doctor if your headache symptoms get worse or occur more often despite treatment at home. Your doctor may refer you to a headache specialist. “No one should go through life suffering from chronic headaches,” Dr.

How do I know if my headache is serious? ›

Your headache comes on suddenly and is explosive or violent. Your headache is "the worst ever," even if you regularly get headaches. You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. Your headache gets worse over 24 hours.

Is NDPH a migraine? ›

New daily persistent headache (NDPH) is a type of headache disorder that starts abruptly and continues daily for at least 3 months. Usually, people with NDPH can clearly recall the exact moment or date when the pain began. The pain may resemble a tension headache, a migraine headache, or a mixture of the two.

Does Botox work for NDPH? ›

We describe a case of NDPH, refractory to different treatments, who after first administration of botulinum toxin type A (195 U) presented a satisfactory remission of pain.

What do tumor headaches feel like? ›

They are often described as dull, "pressure-type" headaches, though some patients also experience sharp or "stabbing" pain. They can be localized to a specific area or generalized. They can be made worse with coughing, sneezing or straining.

Is NDPH a autoimmune disorder? ›

In 1987, Vanast first suggested autoimmune disorder with a persistent viral trigger for CDH (now referred to as NDPH). Post-infectious origins have been approximated to make up anywhere between 30 and 80% of NDPH patients in different studies.

What kind of tests are done for headaches? ›

Headache Diagnosis: Advanced Diagnosis Techniques

Erythrocyte sedimentation rate (ESR), a blood test that can detect inflammation. MRI. CT scan. Digital subtraction angiography, a minimally invasive test that uses X-ray and iodine contrast to produce picture of blood vessels in the brain.

Which tablet is best for headache? ›

Simple pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Combination medications.

Why have I had a headache for 5 days? ›

Anxiety, stress, and mood disorders can trigger headaches that linger for more than a day. Specifically, those with panic disorder or generalized anxiety disorder tend to experience prolonged headaches more often than those without.

Is it normal to have a headache for 7 days? ›

Persistent Headaches

Have you ever experienced a headache that lasted for several days? If so, this is not normal. Although this isn't a sign of a serious or life-threatening health problem, it is a sign that you may have a headache disorder or an underlying problem such as TMJ disorder.

What relieves headaches fast? ›

Tips to Get Rid of a Headache
  • Try a Cold Pack.
  • Use a Heating Pad or Hot Compress.
  • Ease Pressure on Your Scalp or Head.
  • Dim the Lights.
  • Try Not to Chew.
  • Hydrate.
  • Get Some Caffeine.
  • Practice Relaxation.

Why does my headache not go away? ›

There are numerous potential causes, including migraine, a head injury, or a viral illness, such as COVID-19. Anyone who has a headache for days that does not respond to over-the-counter (OTC) pain relief medication should seek guidance from a doctor.

Is it normal to have a headache for 3 weeks? ›

If the headache goes on for a couple of weeks without improvement, or is associated with another neurological symptom, such as weakness on one side of the body, it is recommended to discuss your symptoms with a physician.

What is the most serious headache? ›

Cluster Headaches

These headaches are the most severe. You could have intense burning or piercing pain behind or around one eye. It can be throbbing or constant. The pain can be so bad that most people with cluster headaches can't sit still and will often pace during an attack.

How do I know my headache is not a tumor? ›

The nature of a brain tumor headache is different from a tension or migraine headache in some noticeable ways. For example, waking up frequently with a headache can be a sign of a brain tumor. Keep in mind, however, that other conditions, such as obstructive sleep apnea or a hangover, can also cause morning headaches.

What are my chances of having a brain tumor? ›

Overall, the chance that a person will develop a malignant tumor of the brain or spinal cord in their lifetime is less than 1%.

How do you detect a brain tumor? ›

Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. Sometimes a dye is injected through a vein in your arm during your MRI study.

What is considered to be a disability? ›

The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Is status Migrainosus a disability? ›

The SSA consider a person with migraine disabled if: they experience migraine headaches that prevent them from continuing their job. they are unable to adjust to a different job due to migraine. their headache disorder has lasted or is expected to last at least a year.

Is major depressive disorder a disability? ›

Depression is considered a psychiatric disability under the Americans with Disabilities Act (ADA). It's a significant mood disorder that's known to interfere with daily activities, which may include your ability to work. Depression sometimes becomes so severe that you can no longer go to work.

Does having chronic migraines make you disabled? ›

Chronic migraine (defined as 15+ migraine days a month) is an absolutely acceptable reason to apply for disability. Why? Because some people's migraine attacks are so frequent and incapacitating that they're either completely unable to hold down a full-time job or they need some accommodations in order to do so.

What is the most approved disability? ›

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

How do I know if I am disabled? ›

We consider you to have a qualifying disability under Social Security rules if all the following are true: You cannot do work and engage in substantial gainful activity (SGA) because of your medical condition. You cannot do work you did previously or adjust to other work because of your medical condition.

How long can status Migrainosus last? ›

Status migrainosus is a migraine attack that lasts longer than 72 hours. Learn about symptoms and treatment options. For most people living with migraine, the timeline of an attack is 4-5 hours. But some people get attacks that can last 72 hours or more.

Should I see a neurologist for migraines? ›

If you have severe headaches or accompanying symptoms that are disrupting your life, it might be a good idea to see a neurologist. Consider making an appointment with a neurologist if: Your headache is continuous for more than a day or two. Your headaches tend to come on suddenly.

What does with status Migrainosus mean? ›

Migraines are a type of headache that tend to cause other symptoms, too, such as nausea and vision problems. They can last for a few hours to a few days. But a migraine that lasts for more than 72 hours is called status migrainosus.

Is depression a mental illness or disease? ›

Depression is a common mental disorder. Globally, it is estimated that 5% of adults suffer from the disorder. It is characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities.

Is depression chemical or psychological? ›

Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events.

Can I claim benefits for depression? ›

If your mental health means you find it hard to work or do daily tasks, you could claim benefits. These will depend on the criteria, but can include depression or anxiety. The benefit process can be stressful. There are things you can do if it's affecting your mental health.

What benefits can I claim for migraines? ›

If you experience chronic migraine that makes it difficult or impossible for you to work you can file a claim for Social Security disability benefits. You will need to provide medical documentation of your illness in order for your claim to be approved.

Are migraines diseases? ›

That it's just a headache and that it's no big deal. But migraine is a genetic neurologic disease. It affects each person differently with a wide range of disease severity. Some have infrequent attacks, but others may have frequent disabling attacks.

What shot is for migraines? ›

Sumatriptan injection comes as a solution (liquid) to inject subcutaneously (just under your skin). It is usually used at the first sign of a migraine headache. If your symptoms improve after you use sumatriptan but return after 1 hour or longer, you may use a second dose of sumatriptan.


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