New Daily Persistent Headache

1. Ade Wijaya, MD
October 2017

2.  Introduction
 Epidemiology
 Etiology & pathogenesis
 Clinical manifestation
 Diagnostic criteria
 Differential diagnosis
 Workup
 Management
 Summary

3.  First described in 1986 by Vanast
 Primary headache syndrome
 Don’t forget to exclude secondary causes
 A new-onset headache occurring in a person
who does of frequent headaches and which
then persists on a daily basis for more than 3
months.
 Patients remember the date of onset
 Part of chronic daily headache
Vanast WJ. New daily persistent headaches: Definition of a benign syndronot have a past history me. Headache. 1986;26:318.
Tyagi, A. (2012). New daily persistent headache. Annals of Indian Academy of Neurology, 15(Suppl 1), S62.

4.  Spain; prevalence 0,1 % (Castillo, et al, 1999)
 Norway; preavalence 1,3 % (Grande, et al, 2009)
 In headache subspecialty care from 1.7% to 10.8% in
adults and 13% to 36.1% in teenagers (Gladstein and
Holden 1996, Koenig et al 2002, Bigal et al 2002,
Bigal et al 2004, Mack 2004, Meineri et al 2004, Kung
et al 2009)
 Rates of both coexisting depression (62.2%) (Robbins
et al 2010) and anxiety (45.9%) (Robbins 2011) were
high. One small case series of 9 patients noted the
concomitant onset of panic disorder with new daily
persistent headache (Peres et al 2011).

5.  Persistent CNS inflammation secondary to
glial activation and increase TNF-alfa level in
CSF
 Cervical spine joint hypermobility

6.  Abrupt onset (patients remember the
day/month of the onset)
 Headache onset occurred in relation to an
infection or flu-like illness in 30%, extra
cranial surgery in 12% and a stressful life
event in 12%
 Migraine-like headache
 Family history ?
Robbins MS, Grosberg BM, Napchan U, Crystal SC, Lipton RB. Clinical and prognostic subforms of new daily persistent headache. Neurology. 2010;74:1358–64.
Li D, Rozen TD. The clinical characteristics of new daily persistent headache. Cephalalgia. 2002;22:66–9.

7. Rozen, T. D. (2014). New daily persistent headache: An update. Current pain and headache reports, 18(7), 431.

8. International classification of headache disorders (2nd edition)

9.  Other primary headache (migraine or chronic
TTH)
 Secondary cause
Tyagi, A. (2012). New daily persistent headache. Annals of Indian Academy of Neurology, 15(Suppl 1), S62.

10.  Brain MRI
 Brain angiography
 Laboratory tests (sedimentation rate, Lyme
titer, and thyroid function tests)
 Lumbar puncture
Vanast WJ. New daily persistent headaches: Definition of a benign syndronot have a past history me. Headache. 1986;26:318.
Tyagi, A. (2012). New daily persistent headache. Annals of Indian Academy of Neurology, 15(Suppl 1), S62.

11.  Remitting, relapsing-
remitting, persisting
 Acute treatments:
- Triptans
- IV methylprednisolone
- Nerve blocks
 Prophylaxis treatments:
- Nortriptyline, amitryptilin
- Topiramate, valproate
- Clonazepam
- Botulinum toxin A
- Mexiletine
- Flunarizine
- Fluvoxamine
- Paroxetine
- Baclofen
- Doxycycline
- A TNF-alpha inhibitor
Robbins MS, Grosberg BM, Napchan U, Crystal SC, Lipton RB. Clinical and prognostic subforms of new daily persistent headache. Neurology. 2010;74:1358–64.
Rozen TD. Successful treatment of new daily persistent headache with gabapentin and topiramate. Headache. 2002;42:433.
Prakash S, Shah ND. Post-infectious new daily persistent headache may respond to intravenous methylprednisolone. J Headache Pain. 2010;11:59–66.
Robbins, M. S. (2013). New daily persistent headache. Headache. Oxford: Wiley.

12.  Primary headache with abrupt onset
 Exclude secondary headache
 Persistent inflammatory, role TNF-alfa &
CGRP
 Cervical joint hypermobility
 Remmiting vs relapsing-remitting vs
persisting
 Acute vs chronic treatment