New Daily Persistent Headache

Chronic daily headache affects 4% of the population. Dr Jacques Joubert describes new daily persistent headache, a type of chronic daily headache.

Hello, I’m Dr Jacques Joubert, Clinical Neurologist and Academic Neuroscientist at the Royal Melbourne Hospital. I joined the Virtual Neuro Centre 2 years ago and today I would like to share with you my insights on a condition termed New Daily Persistent Headache.

Chronic Daily Headache is a common condition affecting approximately 4% of the population and is one of the most frequently seen headache types in specialised headache clinics. Chronic Daily Headache is defined as a headache that occurs on at least half the days of the month, and that has been present for at least 3 months. According to the recently revised International Headache Classification, there are 4 major categories of chronic daily headache. These are termed: Transformed Migraine, Chronic Tension-type Headache, New Daily Persistent Headache, and Hemicrania Continua. Of these, the subgroup of headache that has attracted renewed attention recently is that of New Daily Persistent Headache. This arises from the fact that New Daily Persistent Headache is the second most frequent headache type, after Transformed Migraine, seen in adult headache clinics and in one series, 35% of all chronic daily headaches in adolescents, referred to a specialised headache clinic, suffered from New Daily Persistent Headache.

It is striking that although the initial description of New Daily Persistent Headache appeared in the medical literature in 1986, the cause for the condition is unknown and its clinical features have not been well studied. There has been early speculation that New Daily Persistent Headache may be a disorder of the immune system being triggered by a viral infection, however this is as yet unproven. This lack of information regarding New Daily Persistent Headache is particularly of interest in that the condition is a very easily recognisable one to the aware medical practitioner. Because of its only moderately severe pain characteristics and the lack of dramatic associated features, such as vomiting that occurs with migraine, it has probably been overlooked in the past as a form of tension headache. When the patient suffers from New Daily Persistent Headache the following are common complaints: by definition it is a chronic daily headache, present on most if not all the days of the month; according to the current published guidelines for headache diagnosis, the condition has to have commenced within 1-3 days and has continued for at least 3 months. It is of interest that a large number, in fact up to 80% of patients in one study, are able to pinpoint not only the week but the day – and often the time during the day – of the onset of the headache. This is a very important characteristic of New Daily Persistent Headache.

The headache intensity typically varies in severity from day to day and also within the same day. In many patients, the headaches move to different places in the head from time to time and within a day, and also from day to day. In our series, only a small percentage of patients experienced the headaches as fixed to one area. Some patients will experience apart from the headache itself a deep annoying bone pain located to the bones of the face. In this condition patients often complain of sharp, intermittent jabbing pains in the head, however it must be emphasised that the characteristics of the major pain component to this condition is not intermittent but a chronic and persistent one. Excessive fatigue is almost universal in patients with New Daily Persistent Headache. In New Daily Persistent Headache there are few if any features of Migraine, such as nausea, vomiting, light or sound sensitivity, but from time to time these may occur when the headache is severe.

A small but definite minority of patients will complain of tingling and numbness in the fingers and toes and short jabbing pains in different body areas, similar to those experienced in the head. It is of interest that a significant percentage of patients in our series have volunteered that since the onset of the headache they have problems in concentration and their short-term memory has declined.

Although there may be promise in terms of treatment options in the future, currently the condition is considered a difficult management problem. I hope that this thumbnail sketch of an increasingly important headache entity has been useful. We are currently in the process of a prospective study, looking at the clinical, physiological and psychiatric features of this important headache condition.

Thank you for watching and have a great day.

More information on headaches and migraines