Feature Article

New daily persistent headache. If you don’t ask they won’t tell

Feature Article

New daily persistent headache. If you don’t ask they won’t tell

Michael Eller

Figures

© gawrav/istockophto.com model used for illustrative purposes only
© gawrav/istockophto.com model used for illustrative purposes only

Abstract

New daily persistent headache (NDPH) is a morbid headache condition that is under-recognised in the community. It is likely more common in the adolescent population. Initial investigations to exclude a secondary cause of headache are appropriate. An accurate diagnosis helps the patient understand their illness and leads to expectations that mirror their real-world experience, strengthening the therapeutic relationship and diminishing risk of harm. A neurologist and other care providers such as a psychologist should be involved early in the course of management to optimise the chance of success.

Key Points

  • New daily persistent headache (NDPH) presents as an unremitting headache that begins on a given day and is likely more common in adolescents than older adults.
  • It requires distinct work-up and management and is therefore important to recognise.
  • NDPH can be considered a syndrome in that a secondary cause must be excluded. After adequate work up, NDPH can be considered a primary headache condition.
  • The NDPH phenotype can be bland or demonstrate migrainous features such as photophobia.
  • Even a small improvement in pain can significantly improve quality of life.
  • NDPH tends to be ongoing and refractory to treatment, with a high incidence of psychological comorbidity. A multidisciplinary approach to management is therefore recommended.