Overview

A New Daily Persistent Headache (NDPH) is a disorder characterized by intense, persistent headaches for prolonged periods of time. The headaches usually appear suddenly, and they don't go away easily. 

The length and intensity of headaches can affect your emotional and physical health, disrupting sleep patterns and daily activities. Managing life with constant headaches is challenging and can sometimes feel isolating, but you are not alone, and there are ways to feel better. 

Understanding NDPH

What exactly is a headache?

A headache is a pain in the head, usually described as a sharp, throbbing pressure. Based on their underlying cause, headaches are classified into two categories:

1. Primary headaches: They are caused by independent factors, such as lifestyle and poor posture. Examples include migraines, and tension-type headaches (the most common headache type)
2. Secondary headaches: They are mostly caused as a secondary symptom of a disease or infection¹

NDPH is a primary headache condition. However, in some cases NDPH appears to be triggered by secondary symptoms such as stress, or viral infections. This does not classify NDPH as a secondary headache, as the symptoms are the trigger cause, and then the headache becomes an independent ongoing condition.

Diagnostic criteria of NDPH

The headache disorder is characterized by a sudden, relentless pain in the head that does not subside within twenty four hours. This type of headache is present for more than three months.²

Individuals have a clear memory of when the pain started, and most describe it as a migraine-type of pain. In many cases, there is no previous history of frequent headaches. 

Epidemiology of NDPH

NDPH is an uncommon headache condition, affecting 0.03% to 0.1% of the population, with most cases observed in children and adolescents.³

Emotional impact of daily headaches

Dealing with constant, unpredictable headaches can cause a psychological and physical burden. It is common to feel frustrated and overwhelmed, especially when headaches prevent you from doing daily activities. A lot of individuals experience a lack of control, and withdraw from social situations. 

Many people find ways to manage their symptoms and improve their quality of life. It is important not to feel defeated, instead, trust that with time, support, and lifestyle changes, you can regain a sense of control.

Medical management options

There is no standard treatment for NDPH. The symptoms of the condition vary depending on the individual. Some see improvement in their symptoms within 1 year without intervention, others need medical intervention to relieve symptoms, and others might show resistance to therapy. 

The lack of standard treatment makes dealing with DNPH challenging, and healthcare professionals may recommend a trial-and-error approach in order to determine the best individualised treatment. Based on the individual’s length and intensity of symptoms, there are two directions to take:

1. Short-term interventions: this includes pain relievers — medication such as ibuprofen can be used to reduce pain and discomfort
2. Long-Term Interventions: This includes preventive medications — studies in adults and children have shown that antidepressants (e.g. amitriptyline), nerve pain disruptors (e.g. gabapentin and pregabalin), beta-blockers (e.g. propranolol), and anticonvulsants (e.g. topiramate) can be effective in treating NDPH symptoms

Most of this medication is used to treat migraines, and medical professionals often attempt to treat NDPH the same way they treat migraines.⁴

Non-medical management options 

Other ways to manage and relieve symptoms include: 

Ice packs on the neck and/or head 

Cold therapy has been used for treating migraines for over 150 years, with many reporting instant relief from symptoms. The science behind it is that cold, external pressure can reduce inflammation by “cooling” the blood flow to the carotid artery in the neck.⁵

Avoid intense lightning and loud noises

Bright lights and noisy environments can overload the sensory information the brain receives, leading to intensified pain. Avoiding pain-triggering external stimuli when pain is intense can help relieve symptoms. 

Calm the nervous system and reduce stress

Deep breathing allows more oxygen to enter the body and reach the brain. A better-oxygenated brain regulates the nervous system by signifying that no fight-or-flight response is needed. Guided meditation works in the same way. While practicing these techniques, the parasympathetic nervous system is activated, and the body reaches a state of tranquility. 

Biofeedback therapy is an alternative medicine approach, which can be used to control symptoms of NDPH. It works with electrical pads attached to the body, which pick up signals on how your body functions. Signals include heart rate, breathing, and muscle responses. 

Scientific research is limited on biofeedback therapy, and therefore healthcare providers do not use it as a treatment for NDPH, but rather as a way for the patient to understand better how their body works and understand which relief methods might work for them.⁶

Massage and acupuncture can also enhance the mind-body connection and help manage stress, and ultimately, headaches. 

Identify and limit or avoid triggers — such as caffeine, alcohol, and screen time.
Extra tip: Keeping a journal will help you understand patterns in symptoms and identify triggering habits

Caffeine and alcohol in high doses are triggers that can make NDPH symptoms worse by causing inflammation and substance dependence. It is also not advised to mix the two together, as the side effects include high blood pressure and heart palpitations, which can worsen NDPH symptoms.⁷

Screen time can affect your eye health and worsen migraine-like symptoms. 

Dietary changes 

Sugary snacks and processed foods lead to a quick blood sugar spike, which could be a contributing factor to NDPH symptoms. Including anti-inflammatory foods in your diet, such as berries, leafy greens and olive oil can help manage the body’s inflammation levels and may improve NDPH symptoms.

Physical therapy

Physical therapy can address potential musculoskeletal problems and vestibular impairments (impairments in the inner ear which affects balance and coordination) that can contribute to the frequency and intensity of pain. Certain balance exercises may be recommended.⁸

Cognitive Behavioural Therapy (CBT)

This is performed by a therapist, who tries to understand your problems and how you think and act upon them. The therapist guides you on how to seek better approaches to deal with your thoughts and take action. Studies in the paediatric population have shown that CBT can reduce the appearance of headaches and migraines.⁹

Many of these medical and non-medical management options are used to treat chronic migraines and chronic, tension-type headaches. As there is currently no established treatment for NDPH, a combination of medical and non-medical management approaches can be explored to understand what has a positive impact on your quality of life.

Regular consultations with a neurologist and headache specialist can offer guidance and support while you go through managing NDPH symptoms. 

Building a support system

NDPH is often a misunderstood condition. Educating your loved ones about NDPH and what you experience can help you feel less isolated and more understood as you navigate the condition. It can also help your loved ones understand how they can help you. 

Living with chronic pain can be challenging and daunting, but connecting with others also on the journey of dealing with NDPH can give you a feeling of reassurance and encouragement. 

Joining an online or local support group can help foster a community of people who understand how it is to live with chronic headaches. It is important to feel connected during challenging times. 

Important things to remember 

Recovering from NDPH is not always linear. If your symptoms get worse and are not easily manageable, you might need to get re-evaluated by a healthcare professional. Changing a medication or the dosage of it, or combining medication with another type of non-medical approach, can offer relief and make the journey of recovering from NDPH easier. 

It is important to take care of your mental health as much as possible and try to remember that every step forward, even small ones, count. Progress might not be as fast as you’d like, but it is necessary to stay resilient and celebrate small victories. 

Summary

NDPH is an uncommon headache disorder that appears suddenly and then persists daily from its onset for at least 3 months. It can affect individuals of all ages, but adolescents are more prone to it. Chronic headaches can impact mental and physical health, make daily tasks more difficult to complete, and cause people to distance themselves from social activities. There is currently no established treatment for NDPH, and it is mostly treated as a migraine. 

While there is medication and other methods like CBT and physical therapy that can help relieve symptoms, dietary changes, stress-reducing activities, and avoiding triggers can positively impact quality of life as you navigate your way towards healing. 

Every person is different and reacts differently to treatment. Therefore, it is important to consult with neurologists and headache specialists along the way to find the right approach, or combination of approaches, that work well for you and can help you manage NDPH more effectively. 

Connecting with others who are also dealing with NDPH is an important part of the recovery journey. Your mental health matters, and staying hopeful and supported makes a real difference.