In my mind, enduring three pounding headaches – each lasting weeks – in 15 years didn’t make me a typical headache patient. Several doctors shrugged their shoulders and labeled each episode an atypical migraine after MRIs failed to suggest anything else. However, my new neurologist wondered aloud if I wasn’t experiencing a series of events that comprise the condition known as new daily persistent headache.
Overview
New daily persistent headache (NDPH) is one type of chronic daily headaches, according to the Michigan Headache & Neurological Institute, and only recently been acknowledged by specialists as a distinct disorder.
Many patients with headache symptoms are initially diagnosed as suffering from one of the other types of chronic daily headaches. The Mayo Clinic indicates that the other three types include chronic migraine, chronic tension-type headache, and hemicrania continua.
According to Help for Headaches & Migraine, the largest study of NDPH took place in Philadelphia and included 56 patients. Results indicated that one of the oddities of the disorder was that 82 percent of the subjects could pinpoint the exact day when their headaches began. Less than a third of the patients followed had a family history of headaches.
Doctors are quick to admit that they don’t understand well the causes of many chronic daily headaches. The Washington Post indicates that NDPH occurs more frequently in women than in men. The average age of onset if 35. Fortunately, the illness affects less than 1 percent of the U.S. population.
Signs and Symptoms
As is the case with patients suffering from new daily persist headache, my head pain became constant within a few days after it began. I knew exactly when that was and marked it on my calendar.
New daily persistent headache must have at least two of these pain characteristics: occurs on both sides of the head, feels like pressing or tightening but isn’t pulsating, is mild to moderate as far as intensity, or isn’t aggravated by routine physical activity like climbing stairs.
This type of headache also causes no more than one of these symptoms: sensitivity to light, sensitivity to sound, or mild nausea. I experienced none of them. My pain also settled on one side of my head. The neurologist ruled out NDPH.
Diagnosis and Treatment
Before determining that a headache patient is suffering from NDPH, health-care providers must rule out a number of conditions. Among them are a spontaneous cerebrospinal fluid leak, chronic meningitis, blood clots, aneurysms, and cerebral venous sinus thrombosis. In addition, doctors must eliminate medication-overuse headache as a possible diagnosis.
Most patients with this type of discomfort and who finally get the correct name for the problem have seen at least one neurologist or headache specialist. In addition to taking a detailed medical history from the patient and reviewing any records forwarded by the referring physician, the specialist conducts a physical exam.
The biggest problem I faced was not the unremitting pain of my headaches. It was the fact that several times, it was impossible to get an appointment with a specialist until after the headache had vanished. The same was true on two of the three occasions on which I had to undergo an MRI of my head to rule out a host of potential causes like a persistent sinus infection.
New daily persistent headache is one of the most difficult types of headaches for doctors to diagnose and treat. There is no standard treatment for this condition. Individuals tend to be affected over the long term, and treatment is usually trial and error as far as reducing symptoms. Some patients have experienced success as far as prevention with Neurontin or Topamax, both anti-epileptic drugs. Others utilize pain killers and/or antidepressants to help dial down the nerve pain associated with this disorder.
Sources:
http://www.mhni.com/faqs_ndph.aspx
http://www.mayoclinic.com/health/chronic-daily-headaches/DS00646
http://helpforheadaches.com/articles/ndph0905.htm
http://www.washingtonpost.com/national/health-science/a-mans-persistent-headache-proves-hard-to-diagnose-and-harder-to-treat/2012/02/28/gIQAWbWgNS_story.html
Personal experience
