What is NDPH? Let's understand it simply!
Simply put, New Daily Persistent Headache (NDPH) is a type of headache that starts suddenly and lasts for months, and can range from moderate to severe. It is not a serious condition, meaning it is not life-threatening. However, it can completely disrupt your daily activities and lifestyle. It is often difficult to treat. There are two main types of NDPH: 1. Primary NDPH: Doctors also call it (idiopathic) NDPH . This means that no specific cause can be found for why it occurs. 2. Secondary NDPH: It occurs in association with or as a result of another medical condition. Most often, it is caused by a viral illness .Who is most affected by this NDPH situation?
NDPH can develop in anyone. However, it is slightly more common in women. Also, although the condition is most common in children and young adults, especially those between the ages of 10 and 18, it can develop in anyone of any age.How common is NDPH?
There's little research on how common NDPH really is. But based on the data that's available, it's a very rare condition. Studies from countries like Norway and Spain show that it occurs in between 30 and 100 per 100,000 people. So, you can see how rare this is.What happens to our bodies from NDPH?
NDPH mainly affects your brain . However, if you have migraine- like symptoms, you may also experience light sensitivity, sound sensitivity, vertigo, nausea, or vomiting.What exactly are the symptoms of NDPH?
The symptoms of NDPH can be similar to other headaches, but this one is unique.- Headaches are persistent: For a doctor to diagnose NDPH, you must have headaches for at least three months in a row.
- The pain is constant: According to many specialists , once NDPH begins, the pain is constant.
- You remember the day this started: this is something very important.According to the official guidelines of the International Headache Society, to diagnose NDPH, you need to remember the exact day, time, where you were, and what you were doing when the headache started. Imagine, you remember saying, "I was working in the office on Tuesday morning when this headache suddenly came on." That's how clear a memory you need.
- Pain is usually moderate to severe: People with NDPH often have moderate or severe pain. This pain is constant, making it difficult to even do normal activities.
Characteristics of a tension headache:
- Pain on both sides of the head.
- It feels like your head is being squeezed from the inside, like it's being suffocated.
- The pain doesn't increase depending on what you do.
Symptoms of a migraine:
- Pain on one side of the head.
- It feels like a throbbing, pulsating pain.
- Photophobia: Sensitivity to light, pain when looking at light.
- Phonophobia: Sensitivity to sound, pain when hearing sounds.
- Nausea and vomiting .
- Vertigo : Dizziness .
- Visual auras: Seeing various lights and streaks before the eyes.
What are the causes of NDPH? Why does this happen?
Experts still don't know exactly why NDPH develops. However, they suspect that certain events and situations can be triggers . NDPH tends to develop during times of severe stress . NDPH can also develop after certain illnesses. However, there is not enough data to confirm that these are the causes of NDPH. One major trigger is infections . NDPH often develops when there is a viral or bacterial infection. Here are some examples:- Epstein-Barr virus : This is the main cause of the disease called mononucleosis (mono) .
- Salmonella
- E. coli
- Dengue fever:This is very common in our country, isn't it?
- Covid-19 ( COVID-19 )
- Meningitis or Encephalitis: These are types of brain infections.
- Subarachnoid hemorrhage: This is bleeding into the membranes surrounding the brain. It often begins suddenly with a severe, "thunderclap headache."
- Low Cerebrospinal Fluid (CSF) Pressure: This is caused by a leak of CSF from somewhere in the skull or spinal cord. (CSF is the fluid that surrounds and protects our brain and spinal cord.)
- Headache caused by increased CSF pressure.
- Headaches that occur after an injury (e.g., after a concussion ).
- Medication overuse , especially for headaches or migraines, can lead to a condition called "rebound headaches," which means that the headache gets worse after taking the medication.
Is NDPH a contagious disease?
No, NDPH is not contagious from one person to another. Although NDPH can develop after some infections, not everyone who has that infection will develop NDPH.How does a doctor diagnose NDPH?
Diagnosing NDPH is a multi-step process. 1. Step 1: Gather information about your symptoms. This includes how long you have had the headache, when it started, and what you are feeling. 2. Step 2: Rule out other causes of your headache. In the first step, your doctor will ask you questions and examine you. He or she may also perform a neurological exam to see if there is anything wrong with your nervous system. Then, your doctor will want to make sure there is no other cause. The symptoms of NDPH are similar to those of many other neurological conditions.Diagnosing before the three-month period: Often, people seek medical attention before the three-month period required to confirm NDPH has passed. At that point, the doctor may run all the other tests and say "probable NDPH" without finalizing the diagnosis. After you have had symptoms for three months, the doctor can officially diagnose NDPH.
What tests are done to identify NDPH?
There is no specific test that can directly identify NDPH.Instead, tests are done to rule out other diseases that have similar symptoms, especially those that are dangerous or life-threatening. Some of these include:- Computerized Tomography (CT) scan.
- Magnetic Resonance Imaging (MRI) scan.
- Lumbar Puncture (spinal tap): This involves taking a small amount of cerebrospinal fluid (CSF) from the back of the neck, which surrounds the spinal cord, and testing it. This can help detect things like infections and pressure on the brain.
- Blood tests: Check for infections.
How is NDPH treated? Can it be completely cured?
NDPH is often a difficult condition to treat. Some cases, especially those with migraine-like symptoms, can be managed more easily. However, NDPH with tension-type symptoms is less likely to respond to treatment. Time is of the essence. Early treatment is more likely to be effective than years after symptoms begin. Medications are the main treatment for NDPH. However, finding the right medication for this condition can be difficult. Here are some of the medications that can be used:- Antidepressants: Medications such as (Amitriptyline), (Nortriptyline), and (Venlafaxine) can sometimes help with NDPH because they also help with pain control.
- Antiseizure medications: Medications like Gabapentin or Topiramate .
- Botulinum toxin injections: Known to many as Botox® , this blocks nerve signals, including pain signals. Other nerve block treatments may also help.
- Medications to prevent migraines: Beta-blockers (e.g. Propranolol) and Angiotensin-II receptor blockers (e.g. Candesartan).
- Investigational anesthetics/antidepressants: Ketamine, a powerful anesthetic, is being used in research to treat conditions like depression that are not responding to treatment. This may also sometimes help with NDPH.
Complications or side effects of treatment
The complications and side effects of these treatments depend on many things, including the type of medication used. Talk to your doctor about the treatment that is best for you, the possible side effects, and how you can prevent or minimize them.How do I take care of myself or manage symptoms?
It is very difficult to treat NDPH on your own, especially if you do not have a diagnosis. This is because the condition is oftenIt does not respond to common headache medications. This means that not only over-the-counter medications, but also many medications prescribed by a doctor may not be able to stop NDPH.Very important: You should never self-diagnose or self-treat NDPH. This is because a sudden onset of moderate to severe headache can be a sign of a stroke . A stroke is caused by a blockage or other obstruction of a blood vessel in the brain. The longer it takes to get medical attention after symptoms start, the less likely it is that the condition will be reversed. Ultimately, a stroke can lead to permanent brain damage or even death.If you or someone you are with has any of these symptoms, especially along with other signs of a stroke, call 911 (or your local emergency number) immediately. Remember this to recognize the symptoms of a stroke: FAST
- F - Face: Ask the person to smile. Look for one or both sides of the face drooping. This can be a sign of facial hemiplegia or muscle weakness.
- A - Arm: A person who is paralyzed often has muscle weakness or numbness on one side. Ask the person to raise both arms. If there is new weakness or numbness on one side, the other arm will drop down when one arm is raised, or it will not be possible to raise it at all.
- S - Speech: Paralysis can often result in loss of the ability to speak. Speech may become slurred and words may not be chosen correctly.
- T - Time: Time is of the essence, so don't delay in getting help! If possible, look at the clock and remember the time your symptoms started. Telling a doctor when your symptoms started can help them decide what treatment is best for you.
How soon will I feel better after treatment?
Unfortunately, there is no way to tell which of the various treatments will work or not. It is common for many medications to have no effect on NDPH. Typically, a preventive treatment plan takes about six to eight weeks to take effect. Your doctor can give you the best advice on how quickly a medication – if it is effective – will work. He or she will also tell you what to do if the treatment is not successful.Is there a way to reduce or prevent the formation of NDPH?
Unfortunately, NDPH occurs in an unpredictable manner. This means that there is no way to prevent it. Since many of the triggers that can cause it occur unexpectedly, there is no effective way to reduce the risk.If I have NDPH, what should I expect?
If you have NDPH, you can expect to experience moderate to severe headaches. These headaches last for at least three months, are present all the time, and are constant.Some people find relief from treatment, but many do not.How long will NDPH last?
For some, NDPH is something they experience for years, and then it goes away over time. For people in this group, the headaches usually stop within three years. For others, the headaches never go away. When NDPH is unresponsive to treatment and does not go away on its own, the condition can be so severe that it can interfere with things like going to work and participating in social activities. As you learn to live with the condition, you may need the help of a variety of specialists, such as a mental health counselor . It is important to seek treatment for the psychological effects of living with chronic pain.What is the outlook for NDPHs?
NDPH is not a dangerous condition in itself. However, living with moderate to severe chronic pain is known to have a negative impact on a person's mental and emotional well-being. People with chronic pain conditions are more likely to develop mental health conditions such as anxiety and depression . There are several reasons why this condition can be difficult to diagnose:- This situation is rare.
- There are no specific diagnostic tests that can confirm this.
- Scans usually do not show any changes that could explain the symptoms.
How do I take care of my health?
If you have NDPH, your doctor will likely give you suggestions about what you can do to help with the condition. For the most part, there is little that most people can do to manage the condition. However, there is some evidence that focusing on your general health and well-being can increase the likelihood that some treatments – especially medications – will be successful. In general, the health habits that are thought to be most helpful are:- Eat a healthy diet.
- Engage in regular physical exercise.
- Get regular sleep and adequate rest.
When should I see a doctor?
In general, if you have never had headaches before, you should see a doctor if you have a new, moderate headache that meets any of the following criteria:- If over-the-counter medications do not help and/or continue to get worse.
- If it is only on one side of the head, or if there is a throbbing or pulsating pain.
- If you have other symptoms, such as severe nausea and vomiting, or sensitivity to light and sound.
When should I go to the Emergency Department (ETU) ?
Severe headaches that come on suddenly, don't get better, and get worse over time can be a sign of a serious or dangerous condition. There are other symptoms that indicate you should seek medical attention immediately. These include:- Weakness, numbness, or tingling sensation on one or both sides of the body.
- Loss of vision or visual disturbances (e.g., blurred vision, double vision).
- Feeling confused or extremely tired.
- Difficulty maintaining balance or speaking. (Remember, these could be signs of paralysis!)
Is NDPH different from other types of headaches, such as migraines and cluster headaches?
Yes, NDPH is different from other types of headaches. While NDPH can share some of the same characteristics as migraines and other types of headaches, it is different enough that experts classify it as a separate type.Will NDPH ever get completely better?
NDPH works for some people, but not for everyone. However, it is impossible to predict when this will happen or who will get it.When should I be concerned about frequent headaches?
You should be concerned about frequent headaches that are moderate or severe, that don't improve with treatment, or that don't go away on their own. If you have headaches every day, it's a good idea to talk to your primary care provider. While it's common for daily headaches to be caused by mostly harmless reasons, such as needing glasses or contact lenses, they can also be caused by other, more serious, causes.Is it normal to have a slight headache every day?
No, it's not normal to have headaches every day. If you have headaches every day, it's a good idea to talk to a doctor. He or she can determine if your headaches are caused by a serious condition or if you need to see a specialist for further treatment. In many cases, a doctor can help you rule out serious conditions and find ways to stop your headaches or treat them if they occur.Final Take-Home Message
New Daily Persistent Headache (NDPH)It is a rare condition. It is when someone has a new, moderate or severe headache that doesn't get better over time and keeps coming back. It can be difficult to treat, and many people have had the pain and other symptoms for years. Sometimes, headaches go away on their own, but this can happen unexpectedly. While doctors can suggest treatment options, more research is needed to determine why this condition occurs and what treatments are most effective. If you have these symptoms, it's best to see a doctor for advice. Don't suffer alone, ask for help. Headache, Chronic Pain, NDPH, New Daily Persistent Headache, Migraine, Neuropathy, Symptoms👩🏽⚕️ Frequently Asked Questions (FAQ) from the Doctor
💬 Doctors, what is this New Daily Persistent Headache (NDPH)? Is this a dangerous disease?
This NDPH is a headache that starts suddenly and lasts for months. It can range from moderate to severe. But don't worry, it's not a life-threatening condition. However, it can make your daily activities a little difficult.
💬 Doctor, why does this pain occur? Who gets it more often?
Good question. There are two main types of NDPH. Sometimes there is no specific cause for it, which is called 'primary NDPH.' Other times it can be caused by another medical condition, especially a viral infection, which is called 'secondary NDPH.' Although it can happen to anyone, it is more common in women and children between the ages of 10 and 18.
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