New daily persistent headache (NDPH) is a rare disorder that happens unpredictably and for unknown reasons. People with NDPH have a headache that won’t stop and doesn’t get better with common treatments. For some people, the headache can last years or never goes away. Treatment options are available but aren’t always successful.
New daily persistent headache (NDPH) is a rare chronic headache disorder. The symptoms of the NDPH start very suddenly and are moderate to severe. It’s not a dangerous condition, but the symptoms last for months and can greatly disrupt your life and routine activities. Most cases of this condition are also difficult to treat.
NDPH has two main forms, primary and secondary.
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NDPH can affect anyone but is more common in women and people assigned female at birth. It also may happen more often in children and teenagers, especially between ages 10 and 18, but it’s still possible at any age.
There’s limited research on how common NDPH is, but the available data indicates that it’s rare. The best available studies, which are from Norway and Spain, indicate that it happens in 30 to 100 out of every 100,000 people.
NDPH typically only affects your brain directly. However, when it has migraine-like features, it may cause light sensitivity, sound sensitivity, vertigo, nausea or vomiting.
NDPH symptoms aren’t unique, but some happen in an unusual way.
Headaches that happen with NDPH can look like standard tension headaches, migraines or have features of both. Tension headache symptoms can include:
Migraine features can include:
Experts don't know exactly why NDPH happens, but they suspect certain events and circumstances are possible triggers. Going through stressful events is a common feature for people who develop NDPH. People are also likely to develop NDPH after certain medical events, but there’s not enough data to confirm if these events either cause or contribute to NDPH.
One such key type of trigger is having an infection. People often develop NDPH while they have a viral or bacterial infection, including:
You can also have NDPH as a secondary effect of another medical condition that directly affects your brain or central nervous system. Some examples of this include:
No, NDPH doesn’t spread from one person to another. While NDPH can happen after some infections, having those infections isn’t a guarantee of developing NDPH.
Diagnosing NDPH is a multistep process.
The first step usually involves a healthcare provider talking to you and asking you questions. They may also do a neurological exam to check for signs of any related problems with your nervous system.
After the first step is complete, the healthcare provider needs to make sure there isn’t another cause for NDPH. That’s key because NDPH shares so many symptoms with other neurological conditions.
It’s common for people to seek medical care before they reach the three-month requirement for having NDPH. In these cases, your provider will go through all the same diagnostic steps but won’t finalize the diagnosis. In these instances, your provider will diagnose you with “probable NDPH.” Once you reach three months with symptoms, they can formally diagnose you with NDPH.
There aren’t any tests that can directly diagnose NDPH. Instead, tests focus on ruling out other conditions that could cause similar symptoms, especially conditions that are dangerous or life-threatening. Some possible tests include:
Depending on your medical history or the symptoms you describe, your provider may also recommend other tests. You can talk to your provider to learn more about the tests they recommend and the reason for the recommendation. They’re the best source of information relevant to your situation and can tailor the information to your specific circumstances.
NDPH is often a difficult condition to treat. Some cases of this condition are easier to treat, especially those with migraine-like symptoms. Tension headache cases are more likely to resist treatment. Time is also a factor, as NDPH is more likely to respond to treatment when treated earlier rather than years after symptoms begin.
Medications are usually the main way to treat NDPH. However, finding a medication that can treat this condition is often difficult. Some examples of possible medication types include:
The possible complications and side effects that can happen with the treatments depend on many factors, especially the specific medication. Your healthcare provider can tell you more about the side effects and complications that are most likely for you, and what you can do to prevent them or minimize their effects.
Treating NDPH yourself is difficult, especially when you don’t have a diagnosis. That’s because this condition often won’t respond to standard headache treatments. That means over-the-counter medications, and even many prescription medications, aren’t effective at stopping NDPH.
You also shouldn’t try to self-diagnose or self-treat NDPH because a moderate or severe headache that starts suddenly is also a key symptom of a stroke. Strokes happen because of blood clots or other blockages in your brain, cutting off blood flow. The longer you wait to get medical care after symptoms start, the less likely that the symptoms are reversible. Eventually, a stroke causes permanent brain damage or even death.
If you or someone you’re with has this symptom, especially with other stroke symptoms, you should immediately call 911 (or your local emergency services number).
IMPORTANT: To recognize the symptoms of a stroke, remember to think FAST:
Unfortunately, there’s no way to know whether or not different treatments will work. It’s common for many medications to have no effect on NDPH. In general, it takes about six to eight weeks for a preventive treatment plan to take effect. Your healthcare provider is the best person to talk to you about how fast a medication — if effective — should work. They can tell you what you can and should expect, and what you should do if treatment isn’t effective.
Unfortunately, NDPH happens unpredictably. That means there’s no way to prevent it. Many of the possible triggers also happen unpredictably, so there’s also no way to effectively reduce your risk.
If you have NDPH, you should expect a headache with moderate to severe pain. This headache lasts for at least three months, and the pain occurs every day and doesn’t stop. Some people do get relief from treatment, but many don’t.
For some people, NDPH is something they’ll experience for years before it eventually goes away. The headache usually stops within three years for people who fall into this category. In others, the headache never goes away. When people have NDPH that doesn’t respond to treatment and doesn’t stop on its own, this condition can be so disruptive that it interferes with their ability to work, participate in social activities and more. Learning to live with this condition also can involve providers from multiple specialties, such as a mental health provider to treat the psychological effects of living with chronic pain.
On its own, NDPH isn’t a dangerous condition. However, living with moderate or severe chronic pain is known to affect a person’s mental and emotional well-being negatively. People with chronic pain conditions commonly also develop or have mental health conditions like anxiety and depression.
Multiple factors make this condition difficult to diagnose. These include:
Because of all the above factors, people with NDPH may need to see multiple healthcare providers before they get a diagnosis. As this is a condition that providers can only truly diagnose after a person has symptoms for at least three months (though they can diagnose it as a probable case before that), people with NDPH often live with the symptoms without a definite answer on what’s causing their condition. That can further contribute to mental health concerns like anxiety and depression.
If you have NDPH, a healthcare provider can offer suggestions on what you can do to try to help this condition. For the most part, there’s not much that most people can do to manage this condition. However, there’s some evidence that focusing on your general health and well-being can improve the odds that certain treatments — especially medications — will work. In general, the health behaviors that seem most beneficial include:
In general, you should see a healthcare provider if you don’t have a history of headaches and develop a new, moderately painful headache that meets any of the following criteria:
The above criteria aren’t just signs of NDPH, but can also happen with several other severe headache disorders or health conditions. These usually happen with serious conditions that a healthcare provider should examine to see if you have a concern that needs medical care.
Severe headaches that happen suddenly, don’t get better or worsen over time are also potential signs of severe or dangerous conditions. There are also other symptoms that indicate you need to get medical care immediately. These include:
Yes, NDPH is different from other headache disorders. NDPH can share some features with migraines and other headache disorders, but is different enough that experts classify it on its own.
NDPH goes away for some people, but not for all. However, there’s no way to predict when this will happen or to whom.
You should be concerned about recurring headaches that are moderately painful or worse, or that don’t get better with treatment or go away on their own. If you have headaches every day, it’s a good idea to talk to a primary care provider. While it’s common to have daily headaches for mostly harmless reasons, like needing eyeglasses or contacts, you can also have them for other, more serious reasons.
No, it’s not normal to have a headache every day. If you have daily headaches, it’s a good idea to talk to a healthcare provider. They can determine if you have a serious condition that’s causing your headaches or if you need to see a specialist for further care. In many cases, a provider can rule out serious conditions and help you find ways to stop headaches from happening or treat them when they do.
A note from Cleveland Clinic
New daily persistent headache (NDPH) is a rare condition where a person develops a new headache that’s moderately painful or worse and doesn’t get better over time. This condition is difficult to treat, and many people with it have pain and other symptoms for years. Sometimes, the headache goes away on its own, but this happens unpredictably. Healthcare providers can suggest treatment options, but more research is necessary before experts can say why this condition happens and what means are most effective in treating it.
Last reviewed by a Cleveland Clinic medical professional on 08/31/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy