Persistent Headache

New daily persistent headache (NDPH) is a subtype of chronic daily headache. It is bilateral, has a pressing/tightning (non-pulsing) quality, is mild to moderate in intensity, and is not aggravated by routine physical activity.

Primary headache disorders are those for which there is no underlying secondary cause that can be identified. As with Migraine disease and some other headache disorders, there are several secondary conditions that can mimic NDPH, so they must be ruled out before a diagnosis of New Daily Persistent Headache can be confirmed. Two conditions in particular that must be ruled out are spontaneous cerebrospinal fluid (CSF) leak and cerebral venous sinus thrombosis.

If the headache is persistant and localized as it is, an MRI of the brain may be indicated although will probably be of low yield. It may well be a kind of 'status migrainosis' - a self perpetuating migraine headache that needs powerful medication to stop it such as IV infusions of steroids, and DHE (dihydroergotamine). Hemicrania is a similar type of headache but is usually very responsive to indomethacin. Talk to your neurologist about more aggressively breaking the headache cycle.

What is the treatment for NDPH?

Unfortunately, NDPH can be very disabling because it often does not respond to preventive or abortive medications. Some cases have shown successful preventive treatment with Neurontin (gababentin) and Topamax (topiramate). Since it's so difficult to find medications that work and the headache is unremitting, NDPH patients all too often find themselves in the situation of either suffering from medication overuse (rebound) headaches or at the very least, trying desperately to avoid them. Otherwise, since no successful treatment regimens have been devised specifically for NDPH, most specialists work with the same medications prescribed for chronic Migraine.

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