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New Daily Persistent Headaches

Lingering Pain Despite No Headache History

By Betsy Lee-Frye

Updated February 13, 2009

(LifeWire) - New daily persistent headaches may not be the most painful type of chronic daily headache, but they can be one of the most debilitating. As their name suggests, these episodes are a new experience for patients with no history of headaches; they occur frequently and then linger.

Symptoms and Diagnosis

New daily persistent headaches cause a pressing, throbbing, tightening pain on one or both sides of the head. Nausea and increased awareness of light and sound also occur in some patients.

For more than 60% of patients, the pain is mild to moderate. But for nearly 80% of patients, pain continues for longer than eight hours. To be diagnosed with new daily persistent headaches, patients must have pain lasting longer than four hours each day for at least two months. Headaches must be present daily within three days of the initial onset.

To say these headaches strike suddenly would be an understatement. One recent study indicates that nearly 80% of patients can pinpoint the day the pain began. In most cases, these patients have no history of headache or migraine. The sudden onset may coincide with an infection, surgery or stress; however, research linking illness or trauma to these headaches has been inconclusive.

Before diagnosing new daily persistent headaches, physicians should rule out other conditions that can cause similar symptoms: a spinal fluid leak, infection or a blood clot in an artery of the brain. These conditions are serious and require immediate medical attention.

Unlucky Few Affected

New daily persistent headaches are a subtype of chronic daily headaches, termed CDH, which affect approximately 5% of the general population. To be diagnosed with CDH, individuals must have headaches at least 15 days a month for at least one month. For those with new daily persistent headaches, the pain is more frequent and often continues over a longer period of time.

One case study of 651 patients with chronic daily headaches found that less than 2% of these patients had new daily persistent headaches.

The age of onset for new daily persistent headaches ranges from 12 to 78. For women, who are almost 2.5 times more likely to have these headaches than men, the headaches typically begin when they are in their 20s or 30s. Men, however, are typically diagnosed with new daily persistent headaches in their 50s.

Possible Causes

Researchers have yet to find a definitive cause of new daily persistent headaches, but several studies demonstrate an association between the headaches and the presence of an infection.

According to The Headaches, a comprehensive book examining all headaches disorders, some researchers have uncovered a link between the Epstein-Barr virus and new daily persistent headaches. The Epstein-Barr virus is a common virus that is transmitted via saliva droplets and can cause extreme fatigue, swollen glands and in rare cases, an enlarged liver or spleen.  The small, 64-participant study cited in The Headaches found that 85% of individuals with the headaches had an active Epstein-Barr infection, compared with 25% of individuals in the control group.

The hypothesis is that the Epstein-Barr virus, or another infection, might cause neurological inflammation, resulting in the chronic pain symptoms.

New studies have also linked new daily persistent headaches to intracranial hypotension, a complicated condition that occurs when the protective membrane surrounding the brain and spine becomes torn. When a tear occurs, usually resulting from trauma, the fluid surrounding brain and spine begins to leak, causing a drop in pressure.

Other studies have found that hypothyroidism, or an underactive thyroid gland, may be a risk factor for new daily persistent headaches.

Treatment

Some new daily persistent headaches, which are called self-limiting, eventually subside on their own. Others, known as refractory, can last years or even decades.

At this time, there is no data regarding the prevalence of each subtype of new daily persistent headaches. However, according to one study outlined in The Headaches, three months after the initial onset of the headache, 30% of affected men and women reported experiencing no subsequent headaches. Two years after the initial onset of headache, 86% of men and 73% of women also reported experiences no headaches.

Both types of new daily persistent headaches are notoriously resistant to treatment. Some patients get relief from prescription strength anti-inflammatory medications. However, long-term use of these drugs may increase risk of developing a heart attack or stroke, especially among those who have heart disease. Long-term use of these drugs is also linked to stomach and intestinal bleeding.

An anticonvulsant drug called "Topiramate" also shows some promise in treating these types of headaches. However, it too can cause side effects including dizziness, difficulty concentrating, confusion, and increased risk of both kidney stones and osteoporosis. Additionally, Topiramate can make it difficult to sweat, so care should be taken in warm weather climates.

A headache diary is a popular management tool for individuals who experience frequent episodes. By recording the time of headache onset, the activity engaged in at the time of onset, length of the headache (headache triggers) and what, if anything, brings relief, patients can learn to avoid and decrease their pain.

Sources: "Chronic Daily Headaches." MayoClinic.com. 2008. The Mayo Clinic. 8 Apr. 2008. <www.mayoclinic.com/health/chronic-daily-headaches/DS00646/DSECTION=2>.

"CSF Leak." Medical Reference Encyclopedia. 2008. University of Maryland Medical Center. 12 Apr. 2008. <www.umm.edu/ency/article/001068.htm>.

"Diagnosis and Treatment of New Daily Persistent Headache." Michigan Headache and Neurological Institute. 2007. 8 Apr. 2008. <www.mhni.com/faqs_ndph.aspx>.

"Epstein-Barr Virus and Infectious Mononucleosis." National Center for Infectious Diseases. 12 Apr. 2008. Centers for Disease Control and Prevention. 12 Apr 2008. <www.cdc.gov/ncidod/diseases/ebv.htm>.

Krymchantowski, Abouch Valenty. "Primary Headache Diagnosis Among Chronic Daily Headache Patients." Arquivos de Neuro-Psiquiatria. 61. 3. Jun. 2003. <www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2003000300008>.

Nappi, G., A. Perrotta, P. Rossi, and G. Sandrini. "Chronic Daily Headache." Expert Review of Neurotherapeutics. 8. 3. Mar. 2008. 361-384. 8 Apr. 2008. <www.ncbi.nlm.nih.gov/pubmed/18345968?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

Olesen, Jes., Peer Tfelt-Hansen, Peter J. Goadsby, K. Michael A. Welch, and Nabih M. Ramadam. The Headaches. Third ed. Philadelphia: Lippincott, Williams & Wilkins, 2006. 855-856

Schievink, WI, M.M. Maya, F.G. Moser, and J. Tourje. "Spectrum of Subdural Fluid Collections in Spontaneous Intracranial Hypotension." Journal of Neurosurgery. 103. 4. Oct. 2005. 608-613. 8 Apr. 2008. <www.ncbi.nlm.nih.gov/pubmed/16266041?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>. (abstract only)

Tepper, D.E., S.J. Tepper, F.D. Sheftell, and M.E. Bigal. "Headache Attributed to Hypothyroidism." Current Pain and Headache Reports. 11. 4. Aug. 2007. 304-309. 08 Apr. 2008. <www.ncbi.nlm.nih.gov/pubmed/17686395?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>. (abstract only)

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee is an independent journalist living in Kansas City, Mo. Her work has appeared in The Dallas Morning News, Better Homes and Gardens Special Interest Publications and the St. Joseph News-Press.
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