In 2002, Li and Rozen conducted the largest study of NDPH 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 NDPH 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 NDPH?
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 NDPH, most specialists work with the same medications prescribed for chronic Migraine.

Summary:
New daily persistent headache is now classified as a primary headache disorder. As you look at the symptoms, you'll find that some of them are characteristic of tension-type headache; others are more characteristic of Migraine disease. NDPH is unique, however, in that many patients can tell you the exact date when their headache began. It is characterized by continuous daily head pain, varying in intensity, and sometimes accompanied by some Migrainous symptoms. It's important that NDPH be diagnosed carefully and correctly after ruling out other conditions that can present the same symptoms. Unfortunately, at this time, there are no treatments specifically outlined for NDPH.