Definition and Overview
New daily persistent headache (NDPH) is a primary headache disorder defined by daily headache from the moment of onset, persisting without remission for more than 3 months. Patients typically remember the exact date their headache started [1].
Unlike chronic migraine or chronic tension-type headache that evolve gradually, NDPH is daily from its inception. Post-infectious onset is common (30-50%), suggesting autoimmune or neuroinflammatory mechanisms [2].
Subtypes
Self-limiting subtype: resolves spontaneously within several months without specific treatment.
Refractory subtype: persists for years despite multiple treatment attempts. This subtype is notoriously treatment-resistant [3].
Diagnosis
ICHD-3 criteria: persistent headache, daily from onset, lasting more than 3 months, with clearly remembered onset or onset in less than 3 days. Not better accounted for by another headache disorder [1].
Secondary causes must be excluded: low/high CSF pressure headache, cerebral venous thrombosis, medication overuse. MRI with gadolinium and MR venography may be needed.
Treatment
No single treatment shows consistent efficacy. Multimodal approaches include preventive medications (topiramate, gabapentin, amitriptyline), nerve blocks (greater occipital nerve block), muscle relaxants, and behavioral strategies [4]. CGRP monoclonal antibodies are being explored. Doxycycline has shown benefit in cases with inflammatory features.