![]() Mean age of onset in adults is 32.4 years in women and 35.8 years in men and 14.2 in the pediatric population. The age of onset varies from 8 to 78 years. According to some studies female to male ratio was 1.3–2.5:1, but two studies in Japan and India have shown female to male ratio of 0.8:1. NDPH may occur more in women than in men. ![]() In chronic daily headache patients, they found NDPH prevalence of 21–28% in pediatric vs 1.7–10.8% in adult patients. Studies in tertiary headache centers have suggested that NDPH prevalence in children and adolescents is higher than in adults. Since the third version of ICHD has broader criteria for NDPH, the incidence of NDPH is likely to be higher. In a study from Norway of 30,000 persons from the general population using the more strict ICHD-II criteria, 1-year prevalence of NDPH was 0.03% in the age group 30–44 years. The objective of this review is to describe the existing studies of epidemiology, clinical features, trigger factors, pathophysiology and therapeutic options of NDPH. Therefore, a structured review is needed to increase the understanding of this enigmatic disorder. It was not a structured review and new studies have appeared since then. Rozen has published several articles on new daily persistent headache and his review article published in 2014 discussed its definition, pathophysiology and treatment. Therefore, the diagnostic criteria in the ICHD-3β and ICHD-3 did not use any special clinical features, only sudden onset and persistence. Further observations demonstrated, however, that NDPH may sometimes have predominantly migraine features. In the ICHD-2 diagnostic criteria, NDPH diagnosis required characteristics like chronic tension-type headache and presence of migraine features was against the diagnosis of NDPH. In 2004, diagnostic criteria for NDPH were included in ICHD-2 in the chapter “other primary headaches”. described NDPH in 1994 as one of the chronic headache disorders in the “Silberstein-Lipton criteria”. In 1988 when the first version of the International classification of headache disorder (ICHD-1) was published, NDPH was not included because of lack of data. NDPH as an entity has been known since 1986 when it was described by Vanast as a self-limiting and benign form of daily headache. It is very often disabling, may significantly affect the individual’s quality of life and can lead to psychiatric conditions. Although the prevalence of new daily persistent headache is estimated to be rare, it is considered important because of its persistency and therapeutic refractoriness. NDPH predominantly affects individuals without a history of prior headache. New daily persistent headache (NDPH) is a rare primary headache disorder, characterized by persistent headache with a particular temporal profile as it starts 1 day with a clearly remembered onset and continues in a daily pattern without remitting. Multi-center randomized controlled trials are recommended to gain better understanding of NDPH and to establish evidence based treatments. NDPH remains poorly understood but very burdensome for the individual. For patients who do not respond to common prophylactic drugs, ketamine infusion, onabotulinum toxin type A, intravenous (IV) lidocaine, IV methylprednisolone and nerve blockade are possible treatment options, but even aggressive treatment is usually ineffective. It is probably best to treat NDPH based upon the predominant headache phenotype. ![]() Regarding treatment strategy, controlled drug trials are absent. ![]() The diagnosis of NDPH is mainly clinical and based on a typical history, but proper laboratory investigation is needed to exclude secondary causes of headache. The exact pathogenic mechanism of NDPH is unknown, however pro-inflammatory cytokines and cervicogenic problems might play a role in its development. The pain is constant and lacks special characteristics but in some has migraine features. Individuals with NDPH can pinpoint the exact date their headache started. The prevalence of NDPH estimated to be 0.03% to 0.1% in the general population and is higher in children and adolescents than in adults. In this structured review, we describe the current knowledge of epidemiology, clinical features, trigger factors, pathophysiology, diagnosis and therapeutic options of NDPH to better understand this enigmatic disorder. Although rare, NDPH is important because it is one of the most treatment refractory primary headache disorders and can be highly disabling to the individuals. New daily persistent headache (NDPH) presents with a sudden onset headache which continues without remission within 24 h.
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