Definition and Overview
New daily persistent headache (NDPH) is a headache that occurs suddenly at a specific time and continues every day from the beginning, and is classified as a type of primary headache in the International Classification of Headache Disorders, Third Edition (ICHD-3). The name ‘new daily persistent’ reflects the characteristic of headaches occurring suddenly and continuing every day thereafter.
It accounts for approximately 0.1 to 4% of patients visiting headache clinics, and is not uncommon in children and adolescents. Typically, patients often accurately remember the date the headache started, which is a feature that distinguishes it from other chronic headaches.
clinical subtype
New headache is divided into two clinical subtypes according to prognosis.
The self-limiting subtype is a type that improves spontaneously without treatment or in response to treatment within several months. It accounts for approximately 25-35% of the total.
The refractory subtype lasts for several years and responds poorly to multiple treatments. It accounts for approximately 56% of the total and is a form that is difficult to treat. In the refractory type, depression, anxiety, and sleep disorders are more common.
Diagnostic criteria
The ICHD-3 diagnostic criteria are as follows. A. Headache that persists every day within 24 hours and lasts for more than 3 months after onset. B. You can remember exactly when a headache occurred. c. Headaches are typically bilateral, non-pulsatile, and have a pressing/squeezing pattern, but unilateral and pulsatile headaches are also possible. D. Diagnosis is made after excluding secondary headaches.
Secondary headache exclusion must be preceded. The basic evaluation includes brain MRI (with contrast enhancement), cerebrospinal fluid pressure measurement, and blood tests. In particular, cerebral venous sinus thrombosis, intracranial high or low pressure, and meningitis must be distinguished.
Occurring factors
Infection is the most common predisposing factor, with headaches starting after a viral infection or flu-like illness in approximately 30-39% of patients. Epstein-Barr virus and cytomegalovirus are reported to be involved, and recently, cases of new headache after COVID-19 infection have also been reported.
It can also occur after psychosocial stress (divorce, bereavement, work stress, etc.), surgery, trauma, or changes in cerebrospinal fluid pressure. Antecedent causes can be identified in approximately 60% of all patients.
symptoms
The presentation of headaches varies, but the most common feeling is bilateral pressure or tightness. Some patients experience unilateral, pulsating pain, and may also be accompanied by hypersensitivity to light or sound or nausea, making it difficult to distinguish it from chronic migraine.
Headaches last almost 24 hours a day and are often mild to moderate in intensity. Even if you take painkillers, it often does not resolve completely. It is often accompanied by depression, anxiety, sleep disorders, and fatigue, and the headache itself and these psychological symptoms may mutually worsen, forming a vicious cycle.
treatment
There is insufficient evidence to treat new headaches, and preventive treatment strategies similar to those used for chronic migraine or chronic tension-type headache are generally applied.
Preventive drugs include amitriptyline, topiramate, valproic acid, and gabapentin. A response to doxycycline treatment has been reported in some cases of new-onset headache after infection.
Greater occipital nerve block and neuromodulation therapy (transcranial magnetic stimulation, transcranial direct current stimulation) are also considered treatment options. Cognitive behavioral therapy and relaxation therapy contribute to managing accompanying psychological symptoms and improving the ability to cope with pain.