Introduction

Headaches are a very commonly reported issue among the general public, with 4% of all General practice and emergency care enquiries being in relation to this.¹ More often than not, these headaches are of primary origin, with very little understood about secondary headaches. New daily persistent headache (NDPH) is classed as a primary headache disorder, meaning that it occurs without any underlying medications or conditions.² Overtime, ideas around what types of headaches should be classified as an NDPH have evolved due to the different types of chronic headaches that can occur, having similar symptom profiles to NDPH.  Identifying the best management strategies is integral in reducing the impact on quality of life for those who currently suffer from this.

What is NDPH?

New daily persistent headache is a relatively rare condition that affects around 18% of children and 4% of adults currently.³ First discovered in 1986 by Dr Walter Vanast as a benign form of persistent headache, current theories have developed slightly from this viewpoint to better understand how the mechanism of NDPH works.⁴ The International Classification of Diseases (ICD-3) developed by the World Health Organisation (WHO) states that headache onset must become continuous and unremitting within 24 hours and continue for at least three months, with the person also being able to remember very clearly when the exact timing of the pain began.⁵

This specific type of chronic headache can affect any person of any sex and age, with a greater incidence in those under the age of 18 years. In those suffering from these headaches, the most common trigger is a viral or bacterial illness, accounting for 40% of cases.⁶ Certain strains of viruses, including Epstein-Barr virus (EBV) and Dengue fever, have been identified as possible illnesses predisposing people to NDPH, as well as E. Coli and Salmonella bacterial strains.⁷ Other less common causes of NDPH can include surgical procedures requiring intubation and joint hypermobility disorders.

Differentiating between NDPH and other chronic headache disorders like migraines and tension headaches can be quite challenging at first, as a diagnosis of NDPH requires at least 3 months of evidence beforehand. Those suffering from NDPH will typically not experience the symptoms often associated with migraines or raised intracranial pressure (ICP), but can sometimes be present. These include nausea, vomiting, vertigo and vision changes.⁷ Pain is moderate rather than severe and can worsen during physical activity or in the winter months.

Diet and headaches

Diet has long been associated with the worsening of certain headache disorders, including chronic migraine. It is very likely that certain foods and drinks can also influence those suffering from NDPH. Balanced diets rich in fruit, vegetables, omega-3 and wholegrains are recommended for those who suffer from chronic headaches as they are thought to lower inflammation throughout the body. Those with very limited diets, rich in simple sugars and refined carbohydrates, are often more likely to trigger headaches.⁸

Elimination diets, which involve the process of removing one group or one singular food at a time, can be trialled in order to determine what a person may be more sensitive to. Often, foods and drinks containing caffeine, milk, cheese and chocolate can trigger headache onset and are typically the first to be removed from the diet. Alcoholic beverages are also suggested to be a trigger in some 27% of people.⁹ These changes to diets can take some time and determination in order to get it right as they are not going to serve as a quick fix.

Other diets lower in sodium levels may be useful as they can work to lower blood pressure and the incidence of primary headache disorder. The ketogenic diet (Keto) is a diet focused on a lower fat intake, which can help to suppress some cortical functions in the brain related to both seizure activity and the aura often felt before, during and after a migraine episode. For the majority of patients, both the Keto and elimination diets can work fairly successfully in reducing the intensity and longevity of headaches and hopefully new daily persistent headaches also.¹⁰

Suggested diets that can reduce the incidence of headaches:

• Elimination diet - avoiding saturated fats, refined carbohydrates, alcohol, caffeine, etc
• Low-sodium diet
• A high omega-3s and low omega-6s diet
• Ketogenic diet
• Oral magnesium supplements
• Low-calorie diets

Foods to avoid:

• Caffeinated beverages like coffee, tea and energy drinks
• Alcoholic drinks
• High saturated fats - cakes, biscuits, desserts
• High omega-6s - vegetable oils, sunflower seeds, pine nuts, walnuts
• Refined carbohydrates - white bread, white rice, white pasta

Foods to eat:

• High omega-3s - Fish like mackerel, salmon and herring, flax seeds, and chia seeds
• High magnesium - Legumes and seeds, Nuts, wholegrains, bananas, soy products
• Ketogenic foods - High fats and low carbohydrates
• Low sodium - No added salt, fresh fruit and vegetables, fresh dairy products

FAQs

What are the most common symptoms seen in those with NDPH?

Even though NDPH is a completely different condition from migraine disorder and has very specific criteria to be officially diagnosed as NDPH, there are still many similar symptoms between headache disorders. These include sudden onset and continuous tightening pain, nausea, vomiting, blurred vision and sometimes aura symptoms. 

What are the most common alternative treatment options for NDPH?

There are a number of different medications that can be used to lessen the impact of NDPH, which have a varying array of effects on people. There are more technical procedures that can be given, called ‘nerve blocks’, which have been used in children and adolescents, but it has not been studied enough. A serotonin norepinephrine reuptake inhibitor (SNRI) has been trialled and used in some cases of NDPH where they had very intense headaches consistently and had tried other options, which had failed.⁷ This may be another option to help alongside dietary changes.

Summary

New daily persistent headache is a rare yet challenging headache disorder that currently does not have a lot of research into its causes and treatment. There are many similar symptoms in NDPH that are seen with other chronic daily headaches like migraines and tension-type headaches; therefore, many of the treatment and lifestyle options are also similar. Rather than solely relying on medications to hopefully ease the pain felt on a daily basis- trying to remove the triggers that are often food and drink-based can be more beneficial. Further research is needed into NDPH, in particular, the ways in which different diets can help or hinder those suffering.