New Daily Persistent Headache is a primary headache syndrome that involves the abrupt onset of severe, unremitting Headache with no prior history of such Headaches.
Location of Pain
Bilateral location of Headache that is mostly pulsating in character.
Duration of Pain
Constant pain in head lasting for up to 3 months. The New Daily Persistent Headache lasts all day with no pain-free episode in between. The headache occurs more than 15 times a month for 3 months consecutively.
Symptoms
- Photophobia, phonophobia
- Nausea
- Lightheadedness
- Tightening/pressing pain
- Constant pain with no pain-free episode
- Characteristic symptoms of a migraine
- Tension-type headache symptoms
- Most patients with NDPH can pinpoint the exact date of the onset
- Can be an undiagnosed case of Chronic Daily Headaches
The headache reaches its peak intensity in the first three days of onset. The pain may vary in intensity over time but it never goes away throughout the episode.
Causes
Primary cause:
- Hypermobility at the cervical spine joint can lead to the development of NDPH. The hypermobility causes convergence of Cervical and Trigeminal afferents in the Trigeminal nucleus.
- Most of the people develop New Daily Persistent Headache after an episode of nervous system inflammation.
- In some patients with NDPH, Calcitonin Gene-related Peptide was raised, studies suggest that CGRP might have a role to play in inducing New Daily Persistent Headache.
Secondary causes:
A persistent headache can also be caused due to following reasons
- Alteration in levels and volume of Cerebrospinal Fluid causes headaches
- Hypertension
- Subarachnoid hemorrhage
- Post-traumatic headache
- Sphenoid sinusitis
- Medication overuse headache
- Meningoencephalitis
- Neoplasms
Common Triggers
- A recent viral infection affecting nerves like Herpes Zoster
- A spinal tap or lumbar puncture
- Constant stress
Risk Factors
It is seen more commonly in:
- Females, the female to male predisposition is 2:1
- In a wide age group of six years to 70 years, on average 35 years of age
- People who have Chronic Migraines or Tension Headaches.
Diagnosis
- The patient might come up with a history of lumbar puncture or spinal tap.
- The patient might have a history of continuous use of analgesics.
- Headache is mostly unresponsive to other conventional treatments.
- Body Positions do not affect Headache
- MRI is done to rule out other possible causes.
- A CT scan can rule out Venous Sinus Thrombosis.
Treatment
There are two types of NDPH
- Self-limiting: This doesn’t need any sort of medicine and goes away on itself within a year or two of onset.
- Refractory: This does not respond to any sort of treatment and might prolong for many years.
However, to combat the debilitating pain in an acute attack these can be used:
For an acute attack
- Triptans give relief from pain in New Daily Persistent Headache.
- Nerve blocks can be performed according to the location of pain that varies from person to person.
Prophylactics
Botulinum toxin, Clonezipam provides prophylaxis against an attack.
FAQ
It involves the abrupt onset of severe, unremitting Headache with no prior history of such Headaches. Headache is mostly unresponsive to other conventional treatments and is usually not affected by the change in body positions.
Leakage of CSF from puncture hole in the Spinal tap can alter the pressure exerted by the fluid on the brain, thus causing Headache.
A recent viral infection affecting nerves like Herpes Zoster, A spinal tap, or lumbar puncture or Constant stress are some of the risk factors that can trigger an attack.
The self-limiting type of NDPPH lasts up to a year or two at least and then goes away. However, the Refractory type may go away to come back after some time.
