Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 23, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Vanast WJ. New daily persistent headaches: definition of a benign syndrome. Headache 1986; 26:317.
  2. Li D, Rozen TD. The clinical characteristics of new daily persistent headache. Cephalalgia 2002; 22:66.
  3. Rozen TD. Triggering Events and New Daily Persistent Headache: Age and Gender Differences and Insights on Pathogenesis-A Clinic-Based Study. Headache 2016; 56:164.
  4. Mack KJ. What incites new daily persistent headache in children? Pediatr Neurol 2004; 31:122.
  5. Takase Y, Nakano M, Tatsumi C, Matsuyama T. Clinical features, effectiveness of drug-based treatment, and prognosis of new daily persistent headache (NDPH): 30 cases in Japan. Cephalalgia 2004; 24:955.
  6. Diaz-Mitoma F, Vanast WJ, Tyrrell DL. Increased frequency of Epstein-Barr virus excretion in patients with new daily persistent headaches. Lancet 1987; 1:411.
  7. Meineri P, Torre E, Rota E, Grasso E. New daily persistent headache: clinical and serological characteristics in a retrospective study. Neurol Sci 2004; 25 Suppl 3:S281.
  8. Santoni JR, Santoni-Williams CJ. Headache and painful lymphadenopathy in extracranial or systemic infection: etiology of new daily persistent headaches. Intern Med 1993; 32:530.
  9. Evans RW, Rozen TD. Etiology and treatment of new daily persistent headache. Headache 2001; 41:830.
  10. Rozen T, Swidan SZ. Elevation of CSF tumor necrosis factor alpha levels in new daily persistent headache and treatment refractory chronic migraine. Headache 2007; 47:1050.
  11. Bigal ME, Lipton RB, Tepper SJ, et al. Primary chronic daily headache and its subtypes in adolescents and adults. Neurology 2004; 63:843.
  12. Kung E, Tepper SJ, Rapoport AM, et al. New daily persistent headache in the paediatric population. Cephalalgia 2009; 29:17.
  13. Grengs LR, Mack KJ. New Daily Persistent Headache Is Most Likely to Begin at the Start of School. J Child Neurol 2016; 31:864.
  14. Rozen TD. New Daily Persistent Headache. In: Chronic Daily Headache for Clinicians, Goadsby PJ, Dodick DW (Eds), BC Decker, Hamilton, Ontario 2005. p.209.
  15. Young WB, Swanson JW. New daily-persistent headache: The switched-on headache. Neurology 2010; 74:1338.
  16. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  17. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl 1:9.
  18. Robbins MS, Grosberg BM, Napchan U, et al. Clinical and prognostic subforms of new daily-persistent headache. Neurology 2010; 74:1358.
  19. Rozen TD. New daily persistent headache. Curr Pain Headache Rep 2003; 7:218.
  20. Rozen TD. New daily persistent headache: clinical perspective. Headache 2011; 51:641.
  21. Garza I. Images from headache: a "noisy" headache: dural arteriovenous fistula resembling new daily persistent headache. Headache 2008; 48:1120.
  22. Evans RW. New daily persistent headache. Headache 2012; 52 Suppl 1:40.
  23. Evans RW. New daily persistent headache. Curr Pain Headache Rep 2003; 7:303.
  24. Goadsby PJ, Boes C. New daily persistent headache. J Neurol Neurosurg Psychiatry 2002; 72 Suppl 2:ii6.
  25. Mack KJ. New daily persistent headache in children and adults. Curr Pain Headache Rep 2009; 13:47.