New daily persistent headache (NDPH) is one type of chronic daily headache, along with chronic migraine, chronic tension headache, and hemicrania continua. NDPH is being increasingly recognized as an important type of headache, both because of the frequency and also the refractory nature of the head pain.
NDPH develops quickly, usually within hours or one day, but within three days the headache must be constant. Many patients remember exactly what they were doing when the headaches began. The pain is usually bilateral, with aching pressure and/or throbbing. The intensity may vary from mild to severe, but tends to be mild to moderate. The headache is usually constant. At least half of patients describe migraine-associated features, such as nausea, phonophobia, lightheadedness, photophobia, etc. Allodynia, often seen in chronic migraine, is present in approximately a quarter of patients. Autonomic symptoms (nasal stuffiness, conjunctival injection, etc.) may occur.
NDPH is somewhat a diagnosis of exclusion. Infection (including meningitis and sinusitis), mass lesions, subdural hematomas, cerebral venous thrombosis, low or high CSF pressure headaches, arteritis, arterial dissection, post-traumatic, etc., all need to be excluded. Usually the history, along with MRI/MRA, will exclude these entities. There are several newer proposed diagnostic classifications; generally diagnosis includes: at least three months of sudden-onset headache, no significant remission, and no exclusion of other disorders.
NDPH is unilateral in a small number of patients, and if this occurs, with autonomic symptoms, it may represent a variant of hemicrania continua.
