What is the new daily persistent headache?

The new daily persistent headache (NDPH) causes persistent headaches and other symptoms in different periods. A very rare primary headache disorder, meaning it occurs independently of other health problems, NDPH may resemble other types of headaches, such as chronic migraine or tension headaches. Onset is sudden, and people with the disorder are often able to determine when they started experiencing it.

The exact cause of the new daily persistent headaches is unknown, although they often occur with certain infections, including Epstein Barr virus (EBV), among others. Diagnosis may involve blood tests, imaging tests, spinal taps, or other tests to rule out other causes of symptoms. Treatment varies, depending on whether the symptoms are more like a migraine or a tension headache.

Read on to learn more about NDPH, how it’s recognized and treated, and what to do about it.

New Daily Persistent Headache Symptoms

What makes a new daily persistent headache difficult to diagnose is that its symptoms may resemble other types of primary headache disorders, especially migraines, medication-overuse headaches (also known as rebound headaches), and tension headaches. When similar to a migraine, NPHD can cause:

  • severe or tingling headache, sometimes on one side of the head
  • nausea and vomiting
  • Flu-like symptoms at first onset
  • Sensitivity to light, sound, smell, or other stimuli
  • Symptoms worsened by physical activity

The severity of this condition varies from person to person, with some people experiencing only mild tension headaches. These cases usually present with non-throbbing or pounding head pain on both sides of the head.

Notably, NDPH has several features that distinguish it from other headaches and help define the condition clinically. These include:

  • Specific onset: Most patients can identify a specific date when the headache started – without gradual build-up or warning.
  • No history of headaches: NDPH symptoms appear in the absence of any previous history of similar problems and independently of other health conditions.
  • Persistent pain: Pain and other symptoms persist daily for three months or more without relief.


The exact cause of the new daily persistent headaches is unknown. However, studies have shown that they occur as a result of an inflammatory response caused by cytokine release. These are proteins released by certain immune cells that affect other cells. Excessive cytokine levels and other signs of inflammation have been documented in NDPH cases.

This inflammatory response may be the reason why certain viral and bacterial infections are associated with a large proportion, though not all, of cases. These include infections:

  • Epstein-Barr virus
  • herpes simplex virus
  • herpes zoster virus
  • Toxoplasmosis
  • salmonella
  • Streptococcus
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high risk population

Stressful events can sometimes trigger NDPH, and while everyone can develop NDPH, women are 3 times more likely than men to develop the disease. Nearly half of people with this type of headache have close relatives, which also suggests a genetic component.

Diagnosing a new daily persistent headache

As with other primary headache disorders, exclusion of other causes of symptoms is often the most important aspect of the diagnosis. Along with chronic migraine or chronic tension headache, the new daily persistent headache may be similar to several other conditions in that it strikes very quickly. These potentially very dangerous situations include:

  • Brain hemorrhage (brain hemorrhage)
  • Cerebrospinal fluid (CSF) leak (a leak of fluid around the brain and spinal cord)
  • cancer
  • untreated sinus infection
  • very high blood pressure
  • other infections

To rule out these conditions as the cause of persistent headaches, there are several types of tests that can be done:

  • Symptom Evaluation: Your primary care provider and/or headache specialist will review your medical history, assess your symptoms, ask about medications you are taking, and any other health factors that may play a role.
  • Blood tests: A blood sample test can tell a healthcare professional if there is bleeding or a blood clot to rule out a brain hemorrhage or a leak of cerebrospinal fluid. Additionally, they can help detect liver or kidney problems, among other problems.
  • Imaging techniques: Several types of imaging can be used to further screen the brain and head. Computed tomography (CT) scans (3D images produced using multiple X-rays) and magnetic resonance imaging (MRI) of the brain and surrounding veins (called MRV) and arteries (MRA) can help clinicians rule out sudden headaches other reasons.
  • Spinal tap: In some cases, doctors may need to measure cerebrospinal fluid (CSF) levels. This is done by puncturing the lower spine (lumbar spine) with a small needle to draw a small sample for laboratory evaluation.
  • Erythrocyte sedimentation rate: In this test, the sedimentation rate of red blood cells (erythrocytes) in a test tube is measured. If this takes longer, it could indicate an inflammatory response in the body, which could indicate NDPH, among other problems.


The challenge with new daily persistent headaches is that there is no single cure. Management is often multifaceted, and — because symptoms are sequential — medications used for other headache types may not be effective. Using too many of these drugs can lead to a condition called Medication Overuse Headache (MOH), which can actually make the pain worse.

It’s worth noting that the course of treatment may also vary depending on whether the disease is more migraine-like or more like a tension headache. Typically, NDPH is treated in a variety of ways, with patients getting help from headache and pain specialists.

preventive medicine

Several medications prescribed for NDPH are also used to treat migraines. These include:

  • high blood pressure medication, especially Inderal (propranolol) or Atacand (candesartan)
  • Tricyclic antidepressants, including amitriptyline, Pamelor (nortriptyline), or Effexor (venlafaxine)
  • Anti-seizure medications, especially Topamax (topiramate)

Also used in chronic migraine cases to inject Botox A (botulinum toxin injections) into the temples, certain parts of the head and neck and provide long-lasting pain relief. This therapy can be very effective, although repeated treatments (every three months or so) are required.

Avoid Medication Overuse Headaches

Medications that directly control pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, should be used with caution. MOH may occur, as well as dependence on certain medications. Tell your doctor if you take more than twice a week of medication for pain relief.

Biofeedback and relaxation techniques

Since stress is closely related to headaches and headache severity, other approaches focus on relieving stress and promoting relaxation. Biofeedback devices measure physical signs of stress and tension, letting users know when those symptoms are rising and preventing them. Breathing exercises and meditation can also help relieve chronic pain.

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lifestyle changes

Making sure you get good and consistent sleep, regular exercise, and a healthy, balanced diet can also help manage NDPH. These types of changes are often recommended in conjunction with medication or other therapies. They have been shown to help with a variety of chronic pain and headache problems.


This condition can be very debilitating because the symptoms of a new daily persistent headache are ongoing. Clinically, cases are divided into those that are finally resolved, usually within 24 months, and those that are refractory or resistant to treatment. Studies have shown that patients experience NDPH for an average of 3.3 years. However, many people have 5 or even 10 or more.

While there is no one-size-fits-all solution for this condition, continued treatment with medication and lifestyle modifications allows many people to manage and live well with new persistent headaches every day. Most people see their symptoms eventually improve.

Coping With New Daily Persistent Headaches

There is no denying that suffering from chronic pain can have a very serious impact on mental health. As with chronic migraines (defined as 14 or more headache attacks per month), those with new, persistent headaches each day suffer from anxiety, depression, and somatic symptom disorder (a disorder in which physical symptoms are caused by psychological stress) higher incidence. It’s worth noting that the relationship between mental and physical health goes both ways, and one can influence the other.

Living with this condition means not only managing headaches, but also dealing with these related issues. Several strategies can help:

  • Stress management: Adequate sleep, regular exercise, and a good diet are solutions to stress. Because stress and headaches are closely related, preventing stress can help control headaches.
  • Stay engaged: Another way to reduce the burden of chronic headaches is to find ways to stay socially engaged and find activities that satisfy you. Developing hobbies, becoming more involved in your community, and focusing on your relationships with family and friends can all help you avoid focusing on your condition.
  • Consider professional help: A meeting with a mental health professional such as a psychiatrist or psychologist can help you cope with the burden of NDPH and develop strategies for dealing with the emotional impact of living with pain.
  • Seek support: While friends and family can help, you can also benefit from connecting with others with NDPH or other chronic pain conditions. Your doctor or therapist may be able to make referrals online, including on social media, or in person with support groups and advocacy organizations. As a reminder, there are others who are going through a similar experience to you who can provide emotional and practical support.

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New daily persistent headache (NDPH) is a rare disorder characterized by pain in the head that lasts for three months or more. Symptoms range from milder tension headaches to migraine symptoms including very severe, throbbing head pain, nausea, light and sensitivity.

Diagnosis may involve imaging and blood tests, and treatment varies from case to case. Antiseizure drugs and tricyclic antidepressants are among the types of prescription drugs, and lifestyle changes and relaxation techniques complement the treatment of this potentially debilitating condition.

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There is no doubt that new daily persistent headaches are challenging. Essentially, it comes on without warning, the pain persists, and there is no set cure. That said, with medical management—and help from family, friends, and the wider community—the symptoms and burden of this condition can be alleviated.

Our understanding of this and other primary headache disorders is still growing. Treatment and therapy for NDPH will continue to improve over time and research. Not only is it already here to help you, it’s on the way.

Living with Chronic Daily Headaches