New Daily Persistent Headache (NDPH) is a challenging condition that affects many people worldwide. NDPH begins suddenly, with no warning, and often persists relentlessly.
As a headache clinician, I’ve worked with numerous patients who experience the distress and frustration associated with this type of headache.
In this blog, we’ll explore what we currently know about NDPH, what remains unclear, and the treatments that can provide relief, including physiotherapy.
What We Know About New Daily Persistent Headache (NDPH)
NDPH is characterised by a sudden onset of headache that becomes constant and unremitting within 24 hours. Patients often recall the exact day or moment it started, which is unlike many other headache disorders.
Characteristics of NDPH:
- Onset: Typically, NDPH starts abruptly. Unlike migraines or tension-type headaches, which may develop gradually, NDPH comes on quickly and stays.
- Duration: The headache persists for months or years, with patients reporting pain every day.
- Pain: The intensity can range from mild to severe, and it may be bilateral (affecting both sides of the head) or localised.
Research Insights
Studies suggest that some cases of NDPH may be triggered by viral infections, stressful life events, or surgery. However, identifying a precise cause remains challenging, as not all patients have identifiable triggers.
What We Don’t Know About NDPH
Despite ongoing research, the exact cause of NDPH remains elusive. There is no consensus on a single underlying mechanism. While some hypotheses link it to viral infections or immune system dysfunction, others suggest it may be a form of chronic migraine or tension-type headache.
Key Uncertainties Include:
- Pathophysiology: Unlike migraines, where vascular and neurological mechanisms are well-researched, the underlying pathophysiology of NDPH is less understood.
- Predictors of Recovery: While some patients recover spontaneously, others endure chronic pain for years. Identifying which patients will recover remains difficult.
Treatments That Help NDPH
Treatment for NDPH is complex and varies from patient to patient. There is no one-size-fits-all approach, but several therapies have been shown to provide relief.
Medications
- Antidepressants: Tricyclic antidepressants (like amitriptyline) have been effective for some patients, likely due to their impact on neurotransmitters linked to pain regulation.
- Anticonvulsants: Medications like topiramate, commonly used for migraines, may help reduce NDPH pain in certain individuals.
- Non-steroidal Anti-inflammatory Drugs (NSAIDs): Some patients find relief with NSAIDs, although their long-term use must be monitored to avoid overuse headaches.
Physiotherapy: A Key Component of Treatment
Physiotherapy plays a crucial role in managing NDPH, particularly for patients with associated neck tension, posture issues, or musculoskeletal imbalances.
As the principal clinician at the Sydney Headache and Migraine Clinic, I have seen firsthand how targeted physiotherapy can significantly reduce headache frequency and intensity.
How Physiotherapy Helps:
- Posture Correction: Poor posture, particularly in the neck and shoulders, is a common contributor to headaches.
Physiotherapists can assess and correct posture, reducing strain on muscles and joints. - Manual Therapy: Joints in the neck and tight muscles in the upper back can exacerbate headache pain. Treating these areas can help relieve symptoms.
- Strengthening Exercises: Weak neck muscles may worsen NDPH. A tailored strengthening program can improve muscle support and reduce headache symptoms.
A study published in Cephalalgia demonstrated that combining physiotherapy with medication led to improved outcomes for patients with persistent headache disorders. Additionally, patients who receive physiotherapy report better pain management and an improved quality of life.
Lifestyle Modifications
Beyond medications and physiotherapy, lifestyle adjustments can make a significant difference:
- Stress Management: Stress is a common trigger for NDPH. Techniques such as mindfulness, cognitive behavioural therapy (CBT), and relaxation exercises have been shown to reduce headache severity.
- Hydration and Nutrition: Staying hydrated and maintaining a balanced diet can help reduce headache frequency. Some patients find that certain food triggers, like caffeine or processed foods, can worsen symptoms.
Conclusion
New Daily Persistent Headache is a complex and often misunderstood condition.
While we have made significant strides in understanding some of its triggers and potential treatments, much remains unknown. The good news is that patients don’t have to face NDPH alone.
A combination of medication, lifestyle changes, and physiotherapy offers a multi-faceted approach that can significantly reduce symptoms and improve quality of life.
At the Sydney Headache and Migraine Clinic, we are committed to helping our patients find relief through evidence-based treatments, including physiotherapy.
If you or someone you know is struggling with NDPH, we encourage you to seek a comprehensive assessment and explore the treatment options available.
References
- Evans RW, Rozen TD. New daily persistent headache. Headache. 2010.
- Robbins MS, Grosberg BM. The Hypothesis and Uncertainty Around New Daily Persistent Headache. Current Pain and Headache Reports. 2015.
- Lake AE III. Managing Chronic Daily Headache. Headache. 2016.
- Silberstein SD. The Use of Topiramate in the Treatment of Primary Headache Disorders. Headache. 2012.
- Fernandez-De-Las-Penas C. Musculoskeletal Disorders in Headache. Cephalalgia. 2017.
- Wells RE, et al. Stress-Reduction Techniques in Headache Management. Headache. 2018.
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