New Daily Persistent Headache (NDPH)

Written by Paula Ford-Martin, Marijke Vroomen Durning, RN
Medically Reviewed by Zilpah Sheikh, MD on April 09, 2025
8 min read

New daily persistent headache, or NDPH, is a headache that begins suddenly, doesn’t seem to have any specific cause, doesn’t go away with typical headache treatments, and lasts more than three months. 

“It’s an actual diagnosis recognized by the International Headache Society,” says Joey R. Gee, DO, a neurologist at Mission Heritage Medical Group in Mission Viejo, CA. “I don’t think a lot of people understand it. It can last three months and longer, and when you ask [about] the person’s symptoms, they can often pinpoint exactly the day the headache started.”

NDPH causes pain that may get stronger or weaker on any given day, but it’s always there.

Doctors aren't sure exactly what causes NDPH. Some small studies suggest NDPH may be linked to viral and other infections, but more research is needed.

“Sometimes we do find a reason for [the headache],” Gee says. For example, it could be caused by a structural abnormality in the brain called Chiari malformation or a condition like cerebrospinal fluid pressure syndrome. These are called secondary headaches, though. “But the clear definition of new daily persistent headache is that it is classified as a primary headache condition, meaning there’s no known specific cause.”

Although researchers haven’t found a specific cause yet, there are some theories. For example, some people with new daily persistent headache found they started after they had an infection, either caused by a virus or bacteria, such as:

As Gee mentioned, sometimes these headaches could be secondary headaches. Other possible causes include:

  • Cerebrospinal fluid leak
  • Injury to the head, such as a concussion or traumatic brain injury
  • Medication overuse, most often from medications meant to treat headaches and migraines in the first place
  • Subarachnoid hemorrhage, which happens when blood gets into the space between your brain and the outer membrane

Who gets NDPH?

“Anyone can get these headaches,” Gee says. “There may be more females vs. males. Unfortunately, females have more headaches than their male counterparts, except for cluster headaches.” Another group more affected by NDPH includes those aged 10-18. Research shows that more children and teens have this type of headache than adults.

How common is new daily persistent headache?

It’s hard to tell how common new daily persistent headache really is. Studies show that NDPH may affect up to 100 people out of every 100,000. But according to Gee, “Because this condition isn’t seen as often as it is probably present in society, it may be underrecognized and underdiagnosed.”

Symptoms of NDPH can vary. But here are the symptoms that help your doctor make a diagnosis:

  • You can identify almost exactly when the headache began — you may even remember where you were and what you were doing at the time.
  • The pain becomes continuous and nonstop within 24 hours.
  • The headache has lasted at least three months from when it first began.
  • There is no break from the pain.
  • The pain is moderate to severe.
  • The pain can feel like it’s:
    • On both sides of your head
    • Pressing or tightening around your head.
    • Throbbing 
  • Your eyes are sensitive to light, and it might even be painful (photophobia).
  • Your ears are sensitive to noise, and it might even be painful (phonophobia).
  • It might feel like a migraine or tension headache at first.
  • The pain doesn’t worsen with physical activity, such as walking or climbing stairs.
  • You can’t think of any other reason for the headache pain.

But unlike migraines, new daily persistent headache doesn’t cause nausea and vomiting.

There are serious causes that can lead to a sudden headache. So, it’s important to get medical help if you develop a severe headache, especially if it won’t go away. 

There are two steps for diagnosing new daily persistent headaches: gathering the information and then ruling out other possible causes. “The presentation is key, with the history of symptoms, when it started, and the features of the headache,” Gee says. “There’s no trigger like a head injury or trauma. They have a little history of headaches in the past, but nothing chronic or long-term.” He explains that often the physical exam is normal, but tests are often done to rule out other hidden conditions. So, your doctor may order imaging tests such as an MRI or a CT scan to check for conditions that may need immediate treatment. These include:

  • A change in pressure or volume of fluid in your spine. This can sometimes be due to procedures such as a lumbar puncture (also called spinal tap).
  • Meningitis. An infection that causes swelling of the membrane that covers the brain and spinal cord.
  • Head injury. A blow to the head can trigger a sudden, severe, and persistent headache. It can also cause bleeding in the brain, such as subdural and epidural hematoma, which can trigger head pain.
  • Blood clots. Cerebral venous sinus thrombosis is a condition where blood clots form near the brain, causing chronic head pain and other dangerous complications.

When other possible causes for the headaches have been ruled out, your doctor might suspect that you have NDPH.

Gee says that it’s important to work with a neurologist or headache specialist because NDPH is not a common diagnosis and not something a regular doctor would usually see. “We still commonly use medicines that are used routinely for those who have chronic or frequent migraine and tension headaches,” he explains. “It’s a wide range of medications that have been tried, from certain anticonvulsant medications to antidepressants. But it’s interesting. There are many patients who seem to respond to certain treatments of antibiotics or steroids, too.”

Possible treatments for NDPH include:

Sometimes the overuse of analgesic (painkiller) medicines causes a condition called medication overuse headache, or rebound headache. If you have NDPH, your doctor may suggest limiting the amount of analgesics, as too much may cause your head pain to worsen.

Physical therapy may also help ease the pain of NDPH. For some people, NDPH may persist for several years or longer. For others, it may go away much earlier. Researchers continue to look for new and better ways to treat it.

Because chronic pain, such as a daily headache, can affect your mental health, you might want to consider seeing a therapist or counselor who is experienced in working with people who live with chronic pain.

Living with headache pain all day, every day can be challenging. It can affect your work, relationships, and just about every aspect of your life. But getting that first diagnosis can also be confusing; NDPH isn’t something that many people have heard of.

“The first thing I always want to do is to validate that they have this condition,” Gee says. “The second thing is to tell them that it’s not life-threatening; it’s just more disabling. I do educate them that treatment can be hard to manage.”

He explains that the goal of NDPH treatment is to allow some degree of pain relief, but not get rid of it completely. “We do always hope that we can garner some reduction. The first goal is always about 50% reduced intensity and severity of pain, trying to get their lifestyle modifications and their diet better, to get some better control. And then, you know, we go from there. But it is a process.”

Some people with new daily persistent headache never get rid of it. It does go away for about 15% of adults with the condition, while for about 8%, it doesn’t go away completely but comes and goes. This is called relapsing-remitting. If it does go away, it’s usually within three years. 

It might be hard to push yourself to do things while you’re feeling this pain, but it’s important to try to:

  • Move around and be physical. Whether you go to a gym, take daily walks, or work in your garden, movement and exercise can help distract you and maybe help relieve the pain a bit.
  • Eat a healthy diet. A healthy diet is good for your body overall.
  • Try to get enough good-quality sleep. While this might be easier said than done, when we’re tired, we tend to feel pain more acutely. A good rest can help.

Most people with NDPH are able to live a normal life, as they learn how to manage their headaches.

New daily persistent headache, or NDPH, is a real diagnosis for a headache that lasts more than three months without a break and with no clear cause. To diagnose NDPH, doctors need to rule out other possibilities, such as a head injury or migraines. Treatment for NDPH varies. There are many medications doctors can try, and they do help some people with this type of headache. Unfortunately, it can take a lot of trial and error to find relief, and not everyone does.

Is new daily persistent headache a rare disease?

Doctors don’t really know how many people have new daily persistent headache, but it may affect up to 100 out of every 100,000 people.

Is new daily persistent headache a disability?

If the headache is so severe that it affects your work and how you live your life, it might be considered a disability. But most people with NDPH are able to manage their symptoms.

Does new daily persistent headache ever go away?

Some people with NDPH do get relief, and their headache goes away completely. For some, headaches become less severe and appear from time to time. For others, it never goes away.

How do I get rid of a new daily persistent headache?

You would need to work with your doctor, preferably a neurologist or headache specialist, to come up with a treatment plan. Trying to take care of this on your own by taking over-the-counter pain relievers could backfire. Taking these medications too often can result in rebound headaches.