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New daily persistent headache

Ivan Garza, MD
Todd J Schwedt, MD, MSCI
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses characterized by frequent headaches. Chronic daily headache types with individual headaches of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, medication overuse headache, hemicrania continua, and new daily persistent headache. (See "Overview of chronic daily headache".)

Unique to the syndrome of new daily persistent headache (NDPH) is the fact that the headache begins one day and typically does not remit. Many patients can pinpoint the exact date their headache started. New daily persistent headache was first described in 1986 as a benign form of chronic daily headache that improved over time without therapy [1]. However, in other studies and in practice, NDPH can endure for many years or even decades and be completely refractory to treatment.

This topic will discuss NDPH. Other types of chronic daily headache are reviewed elsewhere. (See "Overview of chronic daily headache".)


The pathophysiology of NDPH is poorly understood. Some but not all reports suggest that the onset of NDPH can be triggered by certain events.

In a retrospective series of 56 patients, NDPH onset occurred at the time of an infection or flu-like illness, extracranial surgery, or a stressful life event in 30, 12, and 12 percent of patients, respectively [2]. In a subsequent retrospective analysis of 97 patients with NDPH, 53 percent did not recognize a trigger, while factors identified as triggers included an infection or flu-like illness in 22 percent, a stressful life event in 9 percent, and a surgical procedure in 9 percent [3].


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Literature review current through: Sep 2016. | This topic last updated: May 23, 2016.
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