New daily persistent headache (NDPH) is an unhelpful myth
Researchers in Cincinnati, OH led by Dr. Andrew Hershey reviewed information about the diagnosis, headache features, medication overuse, functional disability in a group of 1,170 children and adolescents with continuous headaches. They compared patients given the diagnosis of chronic migraine with those who were diagnosed as having new daily persistent headache.
The mean age was 14 and 79% of the group were girls. The authors reported that “The overwhelming majority of these youth had headaches with migrainous features, regardless of their clinical diagnosis. Most youth with continuous headache experienced severe migraine-related functional disability, regardless of diagnostic subgroup.”
They concluded that “Overall, youth with continuous chronic migraine and new daily persistent headache did not have clinically meaningful differences in headache features and associated disability. Findings suggest that chronic migraine and new daily persistent headache may be variants of the same underlying disease.”
Here is my take on NDPH adapted from the soon-to-be-released book, The End of Migraine: 150 Ways to Stop Your Pain:
New daily persistent headache (NDPH) is one of the dozens of types of headaches listed in the classification of headaches. This particular listing causes more harm than good. NDPH is defined by the single fact that the headache begins on a certain day and persists without a break. The classification says that NDPH may have features suggestive of either migraine or tension-type headache.
There are no parallels to NDPH in medicine. There is no new daily persistent asthma, or new daily persistent colitis, or any other “new daily” disease.
There does not appear to be any justification for having NDPH as a distinct condition. It does not have a typical clinical presentation and it has not led to any research or treatment. When you search for this condition on the internet, you will not find any effective treatment for it. The suffering of many patients is magnified by the loss of hope, worsening depression, and flagging will to live.
Most importantly, some patients with NDPH do respond to treatment. According to anecdotal reports and in my experience, Botox injections, intravenous magnesium, preventive drugs for migraines, and other treatments can be effective.
In NYC, for CSF leaks, I refer patients to Mt. Sinai Hospital.
Would really appreciate the name of you neuro-interventional radiologist.
“Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache”
Cephalalgia
. 2021 Sep 27;3331024211044440. doi: 10.1177/03331024211044440. Online ahead of print.
Time to retire ‘New daily persistent headache’: Mode of onset of chronic migraine and tension-type headache
Rhannon Lobo 1 , Mu Wang 2 3 , Sean Lobo 4 , Anish Bahra 1 5
Affiliations expand
PMID: 34579562 DOI: 10.1177/03331024211044440
I cannot provide specific recommendations to people who are not my patients. However, I’ve had patients who take a double dose of a triptan at the onset rather than wait for two hours to take a second dose.
I have refractory in the NDPH. I have had continuous headaches for 17 months. Although very little has worked, Zolmaltriptn nasal spray which I have sourced from India can be effective in aborting some of my headaches. My question is whether I can take two sprays of the 5 mg spray dose at the inception of a more severe headache rather than waiting two hours to take the second 5 mg dose. This would be consistent with other comments that Dr. Mauskop has made regarding oral pill forms of triptans. What is your opinion about this?
Kathy, Would you be willing to provide the name of your interventional or Neuroradiologist in New York. I have NDPH and I would like to find out if there is a secondary cause that has not yet been ruled out. I have had imaging that was negative but I don’t think that should be the end of the matter.
I was diagnosed with “New daily persistent headache” several years ago. I had to drop out of school and only work part-time, with no relief coming from medications. I was desperate and my will to live was absolutely waning. Finally, after almost a dozen neurologists, I found an neuro-interventional radiologist in New York (I’m in Atlanta) who found a venous sinus stenosis. He believes this is causing an increase of pressure, and will be placing a stent very soon. I finally have hope that relief can come. I lost five years of finishing school and starting a career, and I’m financially strapped, but hopefully soon I can get my life back. This article gives me hope for others.
I would treat it as migraine. Check out The End of Migraines: 150 Ways to Stop Your Pain.
So what is your opinion for someone who gets a headache and it never stops, for years? your example of asthma does not correlate because someone does not have an asthma attack that starts out of no where and does not ever end.
I am a young man who has been diagnosed with very migrainous new daily persistent headache. It is indistinguishable from the episodic classic migraine attacks of my past. I have triggers that cause worsened episodes that feel quite similar to the baseline. This article brings me hope. The label has been used by multiple neurologists to wipe their hands, simply referring to it as chronic pain and saying the other symptoms are the result of the pain, which I know isn’t true. Meanwhile, the same specialist tried many things with a chronic migraine patient and didn’t give up. My current specialist is more open minded, but has upheld the diagnosis and still does seem to influence their decisions. I see a lot of stories of people’s migraine changing quickly, literally within a day on support groups. The lack of resources and research has made me feel a lot of despair that I won’t get better. This is worsened by hearing doctors at seminars say it is a “different pathway”. In contrast, the migraine label gives me hope, as there is a lot more research already and no doubt more to come. There is also a pipeline new drugs coming to market. Indeed, I have already been helped by the combination of botox and aimovig. I really hope you are right on this.
Just ordered on Amazon! Looking forward to reading it
I hope to have it on Amazone in a couple of weeks
When will your new book be released?