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New daily persistent headache
Classification and external resources
ICD-10 G44.2
ICD-9 339.42

In the last couple of years, New Daily Persistent Headache (NDPH) has been recognized as a distinct primary headache syndrome. It is classified as a Primary Headache Disorder by the ICHD-II classification system (by the IHS) using number 4.8. Primary headache disorders are those for which there is no underlying secondary cause that can be identified. As with Migraine disease and some other headache disorders, there are several secondary conditions that can mimic NDPH, so they must be ruled out before a diagnosis of New Daily Persistent Headache can be confirmed. Two conditions in particular that must be ruled out are spontaneous cerebrospinal fluid leak and cerebral venous sinus thrombosis.

Contents

Symptoms

Diagnostic criteria The International Headache Society. [1]

A. Headache for more than 3 months fulfilling criteria B–D

B. Headache is daily and unremitting from onset or from less than 3 days from onset

C. At least two of the following pain characteristics:

1. bilateral location

2. pressing/tightening (non-pulsating) quality

3. mild or moderate intensity

4. not aggravated by routine physical activity such as walking or climbing stairs

D. Both of the following:

1. no more than one of photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound) or mild nausea

2. neither moderate or severe nausea nor vomiting

E. Not attributed to another disorder

Diagnosis

As mentioned above, other conditions must be ruled out before arriving at a diagnosis of NDPH. Goadsby et al. recommend that evaluation of an NDPH patient should include MRI with and without enhancement and MRA (Magnetic Resonance Angiography). These are done to rule out other conditions such as the spontaneous cerebrospinal fluid leak (aka CSF leak) and cerebral venous sinus thrombosis discussed earlier. If these tests are negative, Goadsby et al. recommend considering a lumbar puncture (spinal tap) to rule out infection as well as conditions related to CSF pressure such as pseudotumor cerebri, which can also mimic NDPH.

Information

1. Headache may be unremitting from the moment of onset or very rapidly build up to continuous and unremitting pain. Such onset or rapid development must be clearly recalled and unambiguously described by the patient.

2. History and physical and neurological examinations do not suggest any of the disorders listed above, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.

Studies

In 2002, Li and Rozen [2] conducted the largest study of New Daily Persistent Headache to date based on 56 patients from the Jefferson Headache Center in Philadelphia. Some interesting points from the study included:

  • 82% of patients were able to pinpoint the exact day their headache started.
  • 29% of the patients had a family history of headache.

Accompanying symptoms:

  • In 30% of the patients, the onset of the headache occurred in correlation with an infection or flu-like illness.
  • 38% of the patients had a prior personal history of headache.
  • 29% of the patients had a family history of headache.

Accompanying symptoms:

  • 68% reported nausea.
  • 66% reported photophobia.
  • 61% reported phonophobia.
  • 55% reported lightheadedness.

Imaging and laboratory testing was unremarkable except for an unusually high number of patients who tested positive for a past Epstein-Barr virus infection.

Treatment

Many doctors consider NDPH to be the most treatment refractory (not responsive to treatment) of headache disorders. Unfortunately, NDPH can be very disabling because it often does not respond to preventive or abortive medications. There are no treatments specifically outlined for NDPH. [3] Some cases have shown successful preventive treatment with Neurontin (gabapentin) and Topamax (topiramate). Otherwise, since no successful treatment regimens have been devised specifically for new daily persistent headache, most specialists work with the same medications prescribed for chronic migraine.

References

  1. ^ The International Classification of Headache Disorders, 2nd Edition." (ICHD-II) September, 2004. www.i-h-s.org
  2. ^ Li, D & Rozen, TD (2002). "The clinical characteristics of new daily persistent headache." Cephalalgia 22 (1), 66-69. doi: 10.1046/j.1468-2982.2002.00326.x.
  3. ^ http://www.healthcentral.com/migraine/types-of-headaches-41643-5.html







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