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Headache is one of the most common complaints in human medicine.

Headaches can be divided into two broad categories:

  • Headaches that appear as a symptom of some other medical condition (systemic infection, head injury, intracranial hemorrhage, brain tumors, etc.), are referred to as secondary headaches.
  • Primary headaches are the result of hypersensitivity of the brain and meningeal structures. These are not caused by other diseases.

Primary headaches include migraine, cluster headache, and tension headache. All primary headaches usually appear in episodes, but if the headache lasts for a longer period of time, intermittently and with no underlying cause, we are probably talking about a syndrome called New daily Persistent Headache (NDPH).

What is NDPH?

NDPH represents a chronic headache which appears suddenly in a person with no history of frequent headaches and lasts longer than three months. An interesting thing about this condition is that patients usually remember the date and situation when the headache first appeared. This condition is listed among primary headache syndromes, and it can affect all the aspects of a person's life.

Clinical Presentation

The main characteristic of NDPH is its sudden onset.

In about a third of all patients, headache's onset was related to a flu-like infection, while a second third of patients reported some stressful event at the time of onset. More than 30 percent of patients could not remember any related events that could precipitate the headache.

Patients are presented with various descriptions of pain which can be sharp or dull, and it is most frequently both-sided although it can affect only one side of the head in some patients. The interval between headaches, their duration and frequency are also variable. Some patients experience the headache 24 hours, 7 days a week, while others have migraine-like attacks lasting for several hours every day.

The pain is rarely described as severe, but it is the duration that makes it debilitating.


Current criteria for diagnosing NDPH are controversial and are not accepted by many scientists because they exclude patients with a previous history of migraine. Studies have shown that persons with migraine issues can also be affected by NDPH. The main criteria include sudden onset headache which lasts for more than 3 months and is present for more than 15 days a month.

Before making the diagnose of NDPH, it is important to eliminate all the possible causes of secondary headache (chronic infection, brain injury, brain tumors, etc.).

In order to evaluate the cause of your headache, your doctor may order blood tests, x-ray of the head, CT scan, MRI, or other functional tests such as PET scan.


Some of the researchers claim that NDPH is the most resistant to treatment of all headaches. Some patients react well to standard migraine medications, while others have no improvement by using drugs. Peripheral nerve blocking was temporarily successful in most of the patients resistant to medications. Earlier studies found that the headache spontaneously dissapeared in almost 90% of men and 75% of women. However, current research suggests that NDPH can last for years and be very disabling.

As there are still no large randomized studies on this condition, more research is needed to evaluate its features and define proper treatment.

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