New Daily Persistent Headache
New Daily Persistent Headache
What is new daily persistent headache (NDPH)?
New daily persistent headache (NDPH) is a primary headache disorder. It falls within the category of chronic daily headaches, which include Chronic Daily Migraine, Chronic Tension Headache and Hemicrania Continua. Like hemicrania continua, NDPH differs from the others in that from the onset it occurs on a daily basis. It is 2 ½ more common in woman then in men. Patients will remember the exact day that their symptoms began. NDPH has a migraine or tension like (or both) quality and may involve all or most of the head on both sides. The pain is often described as throbbing or pressing and may have associated symptoms of nausea and light/sound sensitivity. Pain levels tend to be moderate but may fluctuate from day to day and exacerbations can be severe.
It would not be uncommon for the patient to have experienced some form of surgery, trauma or respiratory/flu-type illness in the weeks leading up to the onset of the headache. It is believed that one important triggering event of NDPH is a form of central nervous system inflammation, as noted by a persistent elevation of a compound called Tumor Necrosis Factor (TNF) in the spinal fluid of this group of patients.
Another important predisposing factor is cervical spine hypermobility. Many patients with NDPH have long, slender necks and have laxity of the joints. It is believed that this predisposes some patients to a cervicogenic component as part of the NDPH.
In the self-limited form of NDPH, approximately 30% will be headache free at 3 months and 70% at two years post-onset. In the refractory form of NDPH, the headaches can go unchanged for years in spite of aggressive treatment.
How is new daily persistent headache diagnosed?
A specialist will take a careful history and perform a detailed neurological examination. Imaging studies and other tests will be performed, in order to exclude underlying conditions which can mimic NDPH. To meet the diagnostic criteria for this disorder, other types of chronic daily headaches must be excluded and daily pain must be present for more than four hours a day for greater than two months.
How is new daily persistent headache treated?
Although individuals with NDPH will occasionally have a favorable response to the traditional preventative migraine medications such as the anti-epileptic agents (Topamax and Neurontin), the majority do not. Muscle relaxants, NSAID and antidepressant medications can also be tried. The antibiotic doxycycline has anti-inflammatory effects has been used with success in a group of patients with NDPH.
Can Interventional Headache Treatment help with new daily persistent headache?
If you have had a thorough neurological examination, appropriate imaging studies and other tests and continue to have symptoms of NDPH, Interventional Headache Treatment may help to manage your symptoms. While NDPH may be difficult to treat, interventional procedures directed at the sphenopalatine ganglion, trigeminal nerve and upper level spinal nerves, can help a subset of patients who suffer with this disorder. Diagnostic local anesthetic injections are used to identify potential structures and nerve pathways which may be associated with the headache. If such a pathway can be identified, then radiofrequency procedures can be used to provide longer term relief. This treatment and others will be discussed as part of your initial consultation.