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New Daily Persistent Headache - The Basics

by Teri Robert, Lead Expert

In the last few years, New Daily Persistent Headache (NDPH) has been recognized as a distinct primary headache syndrome. Primary headache disorders are those for which there is no underlying secondary cause that can be identified.

As with Migraine disease and some other headache disorders, there are several secondary conditions that can mimic NDPH, so they must be ruled out before a diagnosis of NDPH can be confirmed. Two conditions in particular that must be ruled out are spontaneous cerebrospinal fluid (CSF) leak and cerebral venous sinus thrombosis. Headache from a spontaneous CSF leak is usually affected by body position, but the longer it continues, the less apparent that becomes. Therefore, patients may not think to mention that their headache was, at one point, affected by body position, and that maybe missed.

What is new daily persistent headache?
The best way to define NDPH is to excerpt that section of the International Headache Society's
International Classification of Headache Disorders:

4.8 New daily-persistent headache (NDPH)
Previously used terms: De novo chronic headache; chronic headache with acute onset


Diagnostic criteria:

  1. Headache for more than 3 months fulfilling criteria B–D

  2. Headache is daily and unremitting from onset or from less than 3 days from onset

  3. At least two of the following pain characteristics:

    1. bilateral location

    2. pressing/tightening (non-pulsating) quality

    3. mild or moderate intensity

    4. not aggravated by routine physical activity such as walking or climbing stairs

  4. Both of the following:

    1. no more than one of photophobia, phonophobia or mild nausea

    2. neither moderate or severe nausea nor vomiting

  5. Not attributed to another disorder


  1. Headache may be unremitting from the moment of onset or very rapidly build up to continuous and unremitting pain. Such onset or rapid development must be clearly recalled and unambiguously described by the patient.

  2. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5–12 (including 8.2 Medication-overuse headache and its subforms), or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.

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