New Daily Persistent Headache

Over the last several years there have been new developments in the research for NDPH (new daily persistent headache).   This headache is located in the frontal and temporal regions, and peaks maximum intensity over several seconds, lasting up to several minutes, at which point the pain level starts decreasing.  This is recognized (ICD) as a primary headache disorder.  Symptoms are not isolated to one specific demographic, and patients that experience this do not necessarily have any comorbidities or other chronic pain.  Most patients that report this have not had any history of headaches in the past.  Many of these cases are triggered by an illness, infection, or surgical procedure involving intubation.  Other contributing factors could be cervical injury or hyperextension.

The prominent identifier of NPDH is that the patient typically remembers the exact date or circumstance when the headache started, and the 3 days after in which it was unrelenting.  In order to diagnose a patient with NPDH, imaging should include a brain MRI and/or CT scans, in addition to a complete head and neck exam.  In diagnosing NPDH, physicians consider other primary headache syndromes such as chronic migraine and tension headache.  The feature that distinguishes NPDH is the abrupt onset coupled with the daily persistence.  While no guidelines or set treatments exist at this point, it seems to be best treated similarly to the closest manifesting headache phenotype, whether that be migrainous or tension in nature.  There may be an aggravation of an underlying symptom free controlled Temporomandibular Disorder that occurs during intubation for surgery.  TMD can cause frontal and temporal region cephalgia.

 

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