Chronic migraine or something else?
Do you have headache pain every day?
Can you remember the exact day the pain started?
There is another primary headache disorder that mimics the symptoms of Chronic Migraine. It’s called New Daily Persistent Headache, often referred to as NDPH. One of the unique characteristics is that most patients can recall the exact day on which their pain began. The headache pain of NDPH can include symptoms consistent with either migraine or tension-type headache, or both. From the first onset, pain is constant. NDPH is usually diagnosed after extensive testing to rule out other causes, such as a cerebrospinal fluid leak, high spinal fluid pressure pressure, infectious disease, blood clots, or post-trauma headache. Other primary headache disorders must be ruled out, too.
NDPH differs from chronic migraine in that the headache pain is daily from the very beginning. Chronic migraine develops gradually, with symptom frequency increasing over time.
Chronic tension-type headache
While sometimes the pain of NDPH can feel like a tension-type headache, it can just as often feel like a migraine attack. Like Chronic migraine, Chronic TTH develops over time with a gradual increase in frequency and severity. NDPH is daily from the start.
NDPH does not include the autonomic symptoms characteristic of hemicrania continua. There is no tearing, eye redness or swelling, nasal congestion or rhinorrhea.
Medication overuse headache
MOH develops after 3+ consecutive months of using pain medications more than 2-3 times per week. Because NDPH starts with a daily headache, there is no history of medication overuse with a gradual worsening of symptoms. However, patients with NDPH may inadvertently overuse medication prior to seeking medical treatment. If this is the case, a good headache specialist will treat both MOH and NDPH.
There is no treatment specifically recommended for NDPH. More often, it is treated with many of the same medications as Chronic migraine or Chronic TTH. It can be difficult for patients to accept that no cause can be found. About half the time, NDPH starts after and illness or injury. Patients can spend a lot of time questioning the diagnosis and worrying that the cause was missed. Dr. Young shares his wisdom regarding NDPH,
“But after the investigation is complete and the diagnosis is made; then it is time to stop endless investigation and treat. I say this because I have seen too many patients who are fixated on the why they have this headache, and never seriously gotten down to treatment…Most of all, don't give up hope. I believe most people with this condition can find a good to excellent treatment that leads to a vastly improved quality of life.”
How much has your migraine disease changed or evolved over time?