New Daily Persistent Headache (NDPH) is a type of headache condition that starts abruptly and lasts every day for at least 3 months. Usually, people with NDPH can remember the exact time or date when the pain started.
The pain may be similar to a tension headache, a migraine headache, or a mixture of both. Doctors tend to diagnose NDPH when someone does not meet criteria for a different type of headache condition and there is no underlying cause for the pain.
This article looks at NDPH, including its symptoms, treatments, and other potential causes of daily headaches.
NDPH is a primary headache condition, which means it isn’t due to any other health condition. It’s rare but can be debilitating. A unique feature of the condition is that the person usually remembers the specific date or onset of the first headache.
After the onset, the headache becomes persistent within 24 hours. More headaches then continue daily for a longer period of time. NDPH is common in people who have no previous headache history. In about half of the cases it starts after an illness or surgery, but often there is no clear cause.
NDPH is more common in people with a close family member who have chronic headaches and two to three times more common in women, although the reasons for this are unclear.
NDPH is different from persistent headaches that a person may experience from another illness, although symptoms may be similar.
Symptoms of NDPH can include similar symptoms such as tension headaches, migraines, or a mixture of both. A person can experience:
- mild to severe pain
- constant throbbing or pulsating pain
- Pain on one or both sides of the head
- Pain that worsens after physical activity
- Sensitivity to sound, light, or smell
- Nausea or vomiting
Symptoms of NDPH can be similar to other conditions, so it’s important to see a doctor rule out other causes. There is no specific test for NDPH, so doctors diagnose it through an elimination process.
During an appointment, a doctor takes a person’s medical history, asks about their symptoms and when they started, and then orders some tests. These can include:
- Blood tests to rule out inflammatory, infectious, or metabolic diseases
- medical imaging of the brain or blood vessels
- Lumbar puncture
If a person meets the criteria for NDPH and doctors can’t find another underlying cause, they may be diagnosed with NDPH.
NDPH is poorly understood and there is no single treatment. Currently, doctors often recommend treatments for pain relief based on the type of headache that most closely resembles the pain, such as the migraine or tension type.
Some of the medications that can help include:
- Antidepressants that target pain receptors, such as nortriptyline and amitriptyline
- anticonvulsant drugs such as topiramate
- Blood pressure medicines such as candesartan
A 2019 systematic review notes that studies have also looked at an anti-inflammatory drug called methylprednisolone, tetracycline antibiotics, nerve blockers, and botox injections to treat NDPH. Most of these studies were small, but suggest that these options hold promise. More research is needed to confirm how well they work on greater numbers of people.
Because of the potential for a headache to develop from drug overuse, people should try not to rely on short-term medications to treat NDPH, such as over-the-counter pain relievers (OTC). Drugs like barbiturates and opioids are addicting, so doctors shouldn’t prescribe them.
Complementary therapies like biofeedback and relaxation techniques can help people reduce or manage their daily symptoms.
NDPH may be similar to other conditions. These include:
Migraine is a neurological disorder that can cause moderate to severe headaches. A person with chronic migraines has headaches more than 15 days a month and has a full migraine episode or takes pain relievers for at least 8 of those days.
Symptoms of chronic migraines that people experience include:
- Headache, often on one side of the head
- Sensitivity to light, sounds, or smells
- Nausea or vomiting
Some people also experience temporary sensory disturbances before the pain starts. These are known as the aura.
Treatment may consist of people taking prescription drugs to stop the progression of symptoms, which will reduce the frequency of headaches. Some people also find it helpful to try supplements like magnesium, acupuncture, or biofeedback.
Learn more about chronic migraines.
Chronic tension-type headache
Chronic tension-type headache occurs when a person has a tension-type headache for at least 15 days a month. Tension headaches cause various symptoms of migraines. These include:
- Pain similar to the feeling of a tight band around the head
- the feeling that there is a weight on the head
- Pressure or pain around the head
- Neck or shoulder pain
Usually tension-type headaches are mild to moderate in severity and don’t get worse when a person is physically active.
People with occasional tension headaches can take OTC pain relievers, but if those headaches are more common, more frequent use of OTC pain relievers may cause side effects. Preventive approaches such as amitriptyline, massage, physiotherapy, or biofeedback can help people cope with the disease.
Learn more about tension-type headaches.
Hemicrania continua is a rare, chronic headache condition that causes mild to moderate persistent pain on one side of the head. Often there is also severe pain and other symptoms. These can include:
- watery eyes
- Red eyes
- stuffy or runny nose
- drooping eyelid
- Sensitivity to noise, light and smell
The most common treatment for hemicrania continua is indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). It’s the only type of NSAID that works for this condition. NSAIDs can have undesirable side effects, so people who cannot tolerate indomethacin may need to explore other options.
A persistent headache can be a first symptom of COVID-19. Research suggests that headaches can affect 14-60% of people with COVID-19.
Headaches due to COVID-19 can develop quite suddenly and continue each day until a person recovers. Most people experience mild, short-term illness and recover within a few weeks.
In some cases, people with COVID-19 develop persistent symptoms that can last for weeks or months after the initial infection. This is known as Long COVID or Long Distance COVID. People can develop a long COVID-19 illness even if their initial COVID-19 symptoms were mild and headaches are a possible symptom. People with pre-existing migraines may experience worse or more frequent episodes.
If someone develops new persistent headaches and could have COVID-19, they should stay home and check with their local health authority to see how they can get tested.
Learn more about long COVID and its symptoms.
Anyone who has new headaches every day should speak to a doctor. Persistent headaches can be a symptom of many conditions, some of which require treatment.
If a person is experiencing any of the following problems, they should call 911 or their local emergency number:
- sudden, severe headache that feels worse than ever
- Headache, stiff neck and rash that won’t go away under glass
- Headache along with suddenly blurred vision, slurred speech, or paralysis
- Headache along with shortness of breath, blue or white lips and nails, confusion, or difficulty staying awake
- persistent headache after a blow to the head, especially with other symptoms such as drowsiness, confusion or changes in behavior
New Daily Persistent Headache (NDPH) is a primary headache condition that causes chronic, persistent headaches that occur daily for at least 3 months. Usually, people can remember the exact onset of their first headache. In some cases, it starts after an infection or surgery.
Primary headache disorders are not linked to an underlying disease. However, a persistent, chronic headache can be a symptom of another condition in addition to NDPH. These include chronic migraines, COVID-19, and long-term COVID. People who have long-lasting or daily headaches should see a doctor.