This is the condition I've been diagnosed with (headache wise)

[Guest guest]

I was also at Jefferson University (13 days) when I was diagnosed with

this,, but here is some info on it. Kirk

*New Daily Persistent Headache: What Is It?*

In the last few years, New Daily Persistent Headache (NDPH) has been

recognized as a distinct primary headache syndrome. Primary headache

disorders<http://amazon.com/gp/product/1599162091?ie=UTF8 & tag=headacmigrais-20 & l\

ink_code=em1 & camp=212341 & creative=384049 & creativeASIN=1599162091 & adid=b59459de-1\

99c-4e33-bd0c-eea36a16bc09>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 NDPH can be confirmed. Two conditions in

particular that must be ruled out are spontaneous cerebrospinal

fluid<http://headaches.allinfoabout.com/glossary/gloss-cs-fluid.htm>(CSF)

leak and cerebral venous sinus thrombosis. Headache from a spontaneous

CSF leak is usually affected by body position, but the longer it continues,

the less apparent that becomes. Therefore, patients may not think to mention

that their headache was, at one point, affected by body position, and that

maybe missed.

*What is new daily persistent headache?*

The best way to define NDPH is to excerpt that section of the International

Headache Society's International

Classification<http://amazon.com/gp/product/9241545445?ie=UTF8 & tag=headacmigrais\

-20 & link_code=em1 & camp=212341 & creative=384049 & creativeASIN=9241545445 & adid=e8fc4\

77c-9519-4523-a8cd-db04db05294f>of

Headache Disorders:

*4.8 New daily-persistent headache (NDPH)*

*Previously used terms*: De novo chronic headache; chronic headache with

acute onset

*Diagnostic criteria*:

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

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

days from onset

3. 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

4. Both of the following:

1. no more than one of

photophobia<http://headaches.about.com/library/glossary/bl-photophobia.htm>,

phonophobia<http://headaches.about.com/library/glossary/bl-phonophobia.htm>or

mild nausea

2. neither moderate or severe nausea nor vomiting

5. Not attributed to another disorder

*Notes*:

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<http://amazon.com/gp/product/1556159005?ie=UTF8 & tag=headacmigrais-20\

& link_code=em1 & camp=212341 & creative=384049 & creativeASIN=1556159005 & adid=320c0437\

-5d24-4e96-82fb-1735ea9d0cde>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 in groups 5–12 (including

8.2Medication-overuse headache and its subforms), 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.

In 2002, Li and Rozen conducted the largest study of NDPH 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.

-

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 phonophoiba.

-

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.

*How is NDPH diagnosed?*

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<http://amazon.com/gp/product/0932883036?ie=UTF8 & tag=headacmigrais-20\

& link_code=em1 & camp=212341 & creative=384049 & creativeASIN=0932883036 & adid=cc7c62e3\

-2715-4719-9723-7f02b23a5b86>).

These are done to rule out other conditions such as the spontaneous

cerebrospinal fluid (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<http://www.helpforheadaches.com/articles/nihsheets/pseudotumor.htm>,

which can also mimic NDPH.

*What is the treatment for NDPH?*

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. Some cases have shown successful preventive treatment with

Neurontin (gababentin) and Topamax (topiramate). Otherwise, since no

successful treatment regimens have been devised specifically for NDPH, most

specialists work with the same medications prescribed for chronic Migraine.

*Summary:*

New daily persistent headache is now classified as a primary headache

disorder. As you look at the symptoms, you'll find that some of them are

characteristic of tension-type headache; others are more

characteristic of Migraine

disease<http://amazon.com/gp/product/0060766859?ie=UTF8 & tag=headacmigrais-20 & lin\

k_code=em1 & camp=212341 & creative=384049 & creativeASIN=0060766859 & adid=1dea6d4c-ea1\

e-4772-b0ba-71687512501c>.

NDPH is unique, however, in that many patients can tell you the exact date

when their headache began. It is characterized by continuous daily head

pain, varying in intensity, and sometimes accompanied by some Migrainous

symptoms. It's important that NDPH be diagnosed carefully and correctly

after ruling out other conditions that can present the same symptoms.

Unfortunately, at this time, there are no treatments specifically outlined

for NDPH.

------------------------------

*References:*

The International Headache Society. " The International Classification of

Headache Disorders, 2nd Edition. " (ICHD-II) September, 2004. www.i-h-s.org.

Goadsby, J., MD, PhD, DSc, FRACP, FRCP; Silberstein, D., MD,

FACP; Dodick, W., MD, FRCPD, FACP. *Chronic Daily Headache for

Clinicians<http://amazon.com/gp/product/1550092650?ie=UTF8 & tag=headacmigrais-20 & \

link_code=em1 & camp=212341 & creative=384049 & creativeASIN=1550092650 & adid=eded7448-\

5dfb-4b99-9145-47053a4542e8>

*. Hamilton, Ontario: BC Decker. 2005.

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.

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