What are New Daily Persistent Headaches?

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New Daily Persistent Headache, or NDPH, was continually recognized as a distinct primary headache syndrome during the previous years. This disorder has no identifiable underlying secondary cause. Migraine and other illnesses can also be mistaken for new daily persistent headache. Because of this, other diseases that could cause headache should be ruled out first. Cerebrospinal fluid (CSF) leak and cerebral venous sinus thrombosis are two common diseases that should be first considered. Unlike other diseases with headache as a symptom, NDPH patients can precisely remember when the headache started and continue to experience headache since then.

New daily persistent headache can occur in people who have not had any episodes of headache before. Some studies have shown the one possible cause of NDPH is viral infection. It has still not been established if prolonged or additional use of medications contributes as a risk factor for developing NDPH.

What are the signs and symptoms of NDPH?

Several criteria must be met before a headache can be categorized or diagnosed as being new daily persistent headache. First, the patient must be experiencing the headache for more than three months and must occur daily from within three days since it started. Also, the pain should be characterized by having a pressing or tightening quality with mild to moderate intensity. In addition, the pain commonly occurs bilaterally and is not heightened by physical activity. Photophobia, mild nausea or phonophobia may also accompany pain symptoms.

How is NDPH diagnosed?

A diagnosis of new daily persistent headache must be accompanied by results from MRI (magnetic resonance imaging) with or without enhancement, as well as MRA (magnetic resonance angiography) to help in the process of ruling out other conditions such as those mentioned previously. If MRI and MRA results are not conclusive, a lumbar puncture can be done to help identify a possible infection or other conditions which can manifest like NDPH.

What are the possible causes of NDPH?

Researchers found links between having infection due to the Epstein-Barr virus, or EBV, and the occurrence of new daily persistent headache. The EBV is a virus commonly transmitted through saliva droplets. An infection with this as the causative agent can present with symptoms such as extreme fatigue, swollen glands and seldom, with an enlarged liver or spleen. It is hypothesized that the EBV or other possible virus or bacteria can result to neurological inflammation which can have manifestations of pain, especially in the form of headache.

Aside from infection, studies also show possible relationship between intracranial hypotension and NDPH. Intracranial hypotension is a condition characterized by the tearing of the protective membrane surrounding the brain and spinal cord. Because of the tear, and the subsequent trauma, the fluid around the brain and spine leaks resulting to a drop in the pressure.

Other studies also suggest that having hypothyroidism can be considered as a risk factor in having NDPH.

How is NDPH treated?

In some cases, new daily persistent headaches may resolve without need for any treatment after several months. However, because of the consistent and persistent pain, daily activities may be hindered or disrupted. NDPH cannot be prevented or treated using traditional or conventional methods for headache relief. However, studies regarding the use of anti-seizure medicines like Topamax (topiramate) and Neurontin (gabapentin) have been tried. Medications used for migraine are also being tried to treat NDPH. Patients with NDPH must use analgesics with caution to prevent the occurrence of rebound headache.

Regardless of whether or not medications work, it is still best to consult your headache specialist first before trying any treatment for NDPH.

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