New Daily Persistent Headache

Primary new daily persistent headache is a rare disorder of children and adults defined by the onset of daily and unremitting headaches within 3 days of onset lasting 4 hours or more daily. There may be a link between a preceding flu-like or upper respiratory infection in about 15%, a stressful life event in 10%, or extracranial surgery in 10%. Migraine symptoms may be present in over 50%. The headache is generalized in most but may be unilateral in 11% and may be localized to any head region. The diagnosis is one of exclusion as many secondary etiologies can cause similar headaches. The pathophysiology of the primary type is unknown. There are no prospective placebo controlled trials of preventive treatment so prevention is empiric using the same medications for the phenotype of chronic migraine or tension-type headache. Most patients have persistent headaches, although about 15% will remit, and 8% will have a relapsing-remitting type.