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.
In 2002, Li and Rozen conducted the largest study of New Daily Persistent Headache to date based on 56 patients from the Jefferson Headache Center in Philadelphia. Some interesting points from the study included:
- 82% of patients were able to pinpoint the exact day their headache started.
- In 30% of the patients, the onset of the headache occurred in correlation with an infection or flu-like illness.
- 38% of the patients had a prior personal history of headache.
- 29% of the patients had a family history of headache.
- Accompanying symptoms:
- 68% reported nausea.
- 66% reported photophobia.
- 61% reported phonophoiba.
- 55% reported lightheadedness.
- Imaging and laboratory testing was unremarkable except for an unusually high number of patients who tested positive for a past Epstein-Barr virus infection.
How is New Daily Persistent Headache Diagnosed?
As mentioned above, other conditions must be ruled out before arriving at a diagnosis of NDPH. Goadsby et al recommend that evaluation of an NDPH patient should include MRI with and without enhancement and MRA (Magnetic Resonance Angiography). These are done to rule out other conditions such as the spontaneous cerebrospinal fluid (CSF) leak and cerebral venous sinus thrombosis discussed earlier. If these tests are negative, Goadsby et al recommend considering a lumbar puncture (spinal tap) to rule out infection as well as conditions related to CSF pressure such as pseudotumor cerebri, which can also mimic NDPH.
What is the Treatment for New Daily Persistent Headache?
Many doctors consider NDPH to be the most treatment refractory (not responsive to treatment) of headache disorders. Unfortunately, NDPH can be very disabling because it often does not respond to preventive or abortive medications. Some cases have shown successful preventive treatment with Neurontin (gababentin) and Topamax (topiramate). Otherwise, since no successful treatment regimens have been devised specifically for New daily persistent headache, most specialists work with the same medications prescribed for chronic Migraine.
Previous Story
