NDPH (New Daily Persistent Headache)

My Experience

For me, my headache started out extremely severve two days after my wisdom teeth removal. The pain was in the same spot, it felt like it was deep in the head, slightly to the right, and slightly in the back. The pain gradually improved the following couple of months, but remained and then I didn't notice any improvement.

I ended up seeing three different neurologists in the area. I started off with neurontin and was on it for about 2 months, it made me feel dizzy though after I worked out. Then I took vivactil for a few days, but had to stop because it gave me severe heartburn. I was on nortriptyline for 3 months and noticed quite an improvement. I did not have much of a headache during the day, but instead had a lot of head pain, and still, like always, noticed a constant throbbing whenver I lied on my bed or on the couch. I eventually got off of notriptyline because it gave me more severe pain when I increased the dosage without any benefits. I have been on verapamil, but had a rash as a side effect. I also have taken occasionaly some iibproufin or darvocet, which helps, but only temporarily. I have also tried indocin and many herbs such as nettle leaf.

The best doctor for NDPH is Dr. Todd Rozen at the Michigan Head Pain and Neurological Institute.

NDPH Diagnostic Criteria

1. Headache for more than 3 months.
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

In 2002, Li and Rozen conducted the largest study of NDPH to date based on 56 patients from the Jefferson Headache Center in Philadelphia:

• 82% of patients knew 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 patients had a prior personal history of headache.
• 29% of 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) 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?

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). Since it's so difficult to find medications that work and the headache is unremitting, NDPH patients all too often find themselves in the situation of either suffering from medication overuse (rebound) headaches or at the very least, trying desperately to avoid them. Otherwise, since no successful treatment regimens have been devised specifically for NDPH, most specialists work with the same medications prescribed for chronic Migraine.

Summary

As you look at the symptoms of NDPH, you'll find 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 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.

References
1. Teri Robert, New Daily Persistent Headache: The Basics