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  • Updated 08.12.2023
  • Released 12.20.2013
  • Expires For CME 08.12.2026

New daily persistent headache



New daily persistent headache is a unique daily headache syndrome that is characterized by a continuous headache at onset with no clear etiology. In this article, the author reviews the history and classification of new daily persistent headache, followed by its clinical manifestations and its potential etiology and pathogenesis. The differential diagnosis, workup, prognosis, and management are addressed.

Key points

• New daily persistent headache is a daily headache syndrome that begins one day and does not remit. Patients can usually state the day it started. New daily persistent headache can only be diagnosed after 3 months have elapsed and other secondary and primary headache diagnoses have been excluded.

• About 50% of patients report onset of new daily persistent headache around the time of an infection, surgery, or stressful life event. A list of new daily persistent headache mimics can be found in Table 2.

• There are two general subtypes based on the clinical features resembling migraine or tension-type headache.

• The prognosis varies; however, the treatment approach is largely extrapolated from the management of other forms of chronic daily headache.

Historical note and terminology

New daily persistent headache was first described in a case series of 45 patients by Walter J Vanast at the 28th Annual Meeting of the American Association for the Study of Headache (80).

The introduction of the Silberstein-Lipton criteria was a major step forward in the recognition of this syndrome. Published in 1994, it was the first diagnostic criteria of chronic headache disorders and characterized three forms of primary chronic daily headache: chronic migraine, chronic tension-type headache, and hemicrania continua. These criteria specified new daily persistent headache as having an average frequency of 15 or more days per month for at least one month, being frequently constant, developing acutely, not attributable to any other cause, and without a background of escalating migraine or tension-type headache (66).

New daily persistent headache was included in the second edition of the International Classification of Headache Disorders (ICHD-2), which led to its more widespread recognition as a headache syndrome. It addressed some of the clinical features of new daily persistent headache and, for the most part, excluded migraine-like headache features from the diagnosis.

Subsequent case series of new daily persistent headache did not accept such restrictive criteria and found that migraine features are often present in new daily persistent headache (32; 57; 43; 49; 35; 54). Consequently, new daily persistent headache came to be defined as the presence of a continuous daily headache that starts acutely, without any clear secondary cause, and persists for at least three months. The third edition of the International Classification of Headache Disorders (ICHD-3) was updated to reflect this (Table 1) (28).

Table 1. International Classification of Headache Disorders (3rd Edition) Criteria for New Daily Persistent Headache

(A) Persistent headache fulfilling criteria B and C

(B) Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24 hours

(C) Present for more than 3 months

(D) Not better accounted for by another ICHD-3 diagnosis

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