# New daily persistent headache | Symptoms, Causes, Tests and Treatment | OSANG > A new headache is a headache that starts suddenly and continues every day from the beginning. Patients often remember exactly the date and circumstances when their heada… - Official page: https://osns.co.kr/en/encyclopedia/new-daily-persistent-headache - Organization: OSANG Neurosurgery ## Page content Headache ## New daily persistent headache New Daily Persistent Headache · G44.52 New daily persistent headache (NDPH) is a chronic headache that starts suddenly at a certain point and continues every day from the beginning. It is characterized by becoming a headache every day within 3 months of onset. It is one of the primary headaches that does not respond well to treatment even without medication overuse. ## At a glance A new headache is a headache that starts suddenly and continues every day from the beginning. Patients often remember exactly the date and circumstances when their headaches began. It is typically bilateral in the form of pressure or tightness, and continues daily even without overuse of headache medication. It often occurs after infection, stressful events, or changes in cerebrospinal fluid pressure. Because it is highly resistant to treatment, professional headache management is required. - 01Definition and Overview - 02clinical subtype - 03Diagnostic criteria - 04Occurring factors - 05symptoms - 06treatment ## 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. ## Frequently asked questions ### Q01What is New daily persistent headache? A new headache is a headache that occurs suddenly on a specific day and persists every day thereafter. Unlike migraines or tension-type headaches, which gradually increase in frequency and then become chronic, they are characterized by continuing every day from the beginning. Patients often remember exactly when it occurred, saying, “I suddenly had a headache on the ○ day of the ○ month, and the pain has continued to this day.” ### Q02What causes new headaches? The cause is not fully known, but it most often occurs after an infection, especially a viral infection. It also occurs after extreme stressful events, surgery, or changes in cerebrospinal fluid pressure. In some cases, it has been reported to be related to Epstein-Barr virus and cytomegalovirus infection. Recently, cases of new headaches occurring after COVID-19 infection have been reported. The exact mechanism is believed to involve neuroinflammatory or vascular reactivity abnormalities. ### Q03How is new headache diagnosed? According to the International Headache Society's diagnostic criteria, a headache must have a clearly remembered onset, be a daily headache within 24 hours, and persist for more than 3 months. Secondary headaches (brain tumor, meningitis, subarachnoid hemorrhage, etc.) must be excluded first. Diagnosis is made after conducting tests to rule out secondary causes, such as MRI, blood tests, and cerebrospinal fluid tests. ### Q04Can new headaches be treated well? New headaches are highly resistant to treatment. Some patients improve spontaneously within a few months to a year, but in many cases the condition persists. A variety of treatments are attempted, including migraine preventers (topiramate, amitriptyline, valproic acid), antibiotics (doxycycline), antidepressants, and nerve blocks, but response rates vary. It is important to not give up and find the right treatment with a professional headache doctor. ### Q05If a headache persists every day, is it a new headache? No. There are many different causes of chronic headaches. Chronic migraine, chronic tension-type headache, medication overuse headache, and secondary headaches (brain tumor, abnormal intracranial pressure, etc.) can also cause daily headaches. The key characteristic of new headaches is that they persist from day to day. This is different from cases where the frequency gradually increases and becomes chronic. You must see a neurologist for accurate diagnosis and exclusion of secondary causes. ### Q06Are stress or autonomic nerves related to new headaches? Yes, there is research showing that psychological stress and autonomic imbalance are related to new headaches. In heart rate variability tests, autonomic dysregulation has been reported in patients with new-onset headaches, and in particular, a decrease in parasympathetic nerve activity has been observed. An integrated approach aimed at managing stress, improving sleep, and normalizing autonomic function may be helpful in treatment. ## Related articles - giant cell arteritis - Hemicrania continua - Hypnic Headache - Idiopathic intracranial hypertension This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.