New Daily Persistent Headaches

Medically Reviewed by Jennifer Robinson, MD on March 17, 2023
3 min read

You probably remember exactly when your pain started. New daily persistent headaches (NDPH) begin without warning and go on for 3 months or longer.

The pain may get stronger or weaker each day, but it's always there. There are medicines that can give you relief. Pain management tools like biofeedback and relaxation techniques can also help you feel better.

The pain of NDPH becomes steady within 24 hours of its start. It may feel similar to a tension or migraine headache.

You may have pain on both sides of your head. At the same time, you may be sensitive to light or sound.

Most headaches are throbbing in nature. But they can come on as a stabbing, aching, tightening, or burning pain.

Get medical help right away for any new and severe headache. There are serious causes of head pain that can lead to a sudden headache. Your doctor may order imaging tests such as an MRI or a CT scan to rule out 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, or "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 an area of bleeding on the brain, known as subdural and epidural hematoma, that 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.

Your doctor will probably recommend medicine to ease your pain. It may take some trial and error until you and your doctor find a medicine that works for you.

Treatments for NDPH include:

Antiseizure, or anticonvulsant, drugs. Gabapentin (Gralise, Horizant, Neurontin), topiramate (Eprontia, Qudexy XR, Topamax , Trokendi XR), and valproic acid (Depakene, Depakote) are commonly prescribed.

Muscle relaxant drugs. These drugs relax tense muscles and include baclofen (Lioresal , Ozobax ) and tizanidine (Zanaflex).

Antidepressants called SSRIs (selective serotonin reuptake inhibitors). These include fluoxetine (Prozac), paroxetine (Brisdelle, Paxil, Pexeva), sertraline (Zoloft), and venlafaxine (Effexor).

Tricyclic antidepressants. These are older antidepressant drugs that include amitriptyline, doxepin (Silenor), nortriptyline (Aventyl, Pamelor), and protriptyline (Vivactil).

Migraine drugs called triptans. Some examples are almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). 

NSAIDs (nonsteroidal anti-inflammatory drugs). These painkillers include aspirin, celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen, and naproxen.

Sometimes the overuse of analgesic 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.

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