Published by: Sarah on 20th Apr 2014 (http://living-with-ndph.network-maker.com/members/profile/24/blog-view/blog_9.htm)
First, I would like to say, writing this is not easy for me. I don’t usually express my thoughts or feelings to others, for the simple fact that this is my life/ problem not anyone else’s. I am not looking for sympathy or anything, just thought it was time, because I keep getting questions about what is going on with me. I guess I have decided it is time to bring awareness not only to my chronic pain, but others as well. Granted I do not know what anyone else goes through, I do know what I feel and go through (most of the time).
I have New Daily Persistent Headaches (NDPH), I have been suffering from these headaches for 4 years this month. It is like one day the light switch turned on for headaches and has never been shut off. I experienced migraines when I was younger, they were the typical text book migraines. Light/ sound sensitive, blah, blah, blah.
But this headache is different, there is pain in the middle of my head/ brain, from within not in the frontal area (migraine pain), or back of the head/ neck (stress headache), cluster, sinus, ocular migraines, hemicranias continua, status migrainosus, etc., of the 150 different types of headaches that have been diagnosed over the years. I have continuous pain, excruciating pain that doesn’t stop. I have this pain 24/7/365. I can only describe it as from within, pressing upward and outward, lots of pressure from within but also pressing down on my neck. It feels like a 20 lb. bowling ball is resting on my neck at most times. I also have fibromyalgia (which is unexplained pain throughout my body), I have been diagnosed with an amnesiatic/ early onset Alzheimer’s tendencies. Because of this I also suffer depression and severe anxiety. The list can go on and on. The main thing that it boils down to is I have… CHRONIC PAIN.
I know there are many people in this world who suffer from chronic pain, over 1.5 billion (in the world) people to be exact. Which seems like a staggering amount, seems like that number is too high. I don’t pretend to think I am worse off than anyone else, who suffers. We all feel the pain differently, we can cope or deal with things.
I have tried so many different medications, not only prescription but samples from 2 different neurologists over the last year, it ranges in one year about 75 medications. I have tried several different treatments, infusions, chiropractic, meditation, pain management, etc. I don’t take pain medication because it doesn’t work for me. And a misconception, sex does not cure all headaches, yes it is proven it can help some… but it does not help me! I have not found anything to relieve this pain, in any way shape or form. I have not had relief from this pain since 2010.
I don’t remember much of any day. I have lists to remind me to do things. I have 3 different calendars I look at to remember anything and everything important. And yet I still forget many more things then I care to admit. I admit I don’t remember much about anything, I don’t remember my days, conversations, even as much as I hate to say it, even people. I can tell someone I will call or text, and as many will attest, I don’t do what I say. And I hate to say, that is one of my biggest pet peeves, it is rude and inconsiderate, but yet I am so guilty of doing exactly that. I won’t use my health as an excuse, it is something I have accepted, I don’t like it but it has become who I am. I use to remember everything, I mean everything.
I have been become anti-social, I detest most public situations, because of the anxiety I feel. It isn’t a feeling of judgment, it is a feeling of fear and uncontrollable communication. I hear many conversations, including if I am trying to hold one, and I cannot process what is being said, because I can’t focus. I lose my thoughts in everyone else speaking. I forget what I am going to say or even completely go off subject. I will say something that has no correlation with what is happening around me.
The following is what the “description” what NDPH is from Wikipedia…
New daily persistent headache (NDPH) is a distinct primary headache syndrome which can mimic chronic migraine and chronic tension-type headache. The headache is daily and unremitting from very soon after onset (within 3 days at most), in a person who does not have a past history of a primary headache disorder. The pain can be intermittent, but lasts more than 3 months.
The striking feature of the condition is its abrupt onset. Patients often remember the date, circumstance and indeed, occasionally, the time of headache onset. One retrospective study stated that over 80% of patients could state the exact date their headache began.[1]
The syndrome is difficult to treat and may persist for years.
The cause of NDPH is unknown, and it may have more than one etiology. NDPH onset is usually in relation to an infection or flu-like illness, stressful life event, minor head trauma, and extra cranial surgery. Infection or flu-like illness and stressful life event are most often cited.[1] The pathophysiology of NDPH is poorly understood.
The age of onset ranges from 6 to greater than 70 years old, with a mean of 35 years. It is found to be more common in females in both the adult and pediatric populations. NDPH is rare. The Akershus study of chronic headache, a population based cross sectional study of 30,000 persons aged 30–44 years in Norway, found a one-year prevalence of 0.03 percent in the population.[2]
In 1986, Vanast was the first author to describe the new daily-persistent headache (NDPH) as a benign form of chronic daily headache (CDH).[3] The criteria for the diagnosis of NDPH were proposed in 1994 (the Silberstein–Lipton criteria)[4] but not included in the International Classification of Headache Disorders (ICHD) until 2004.
The headaches can vary greatly in their clinical presentation and duration.
Quality of the headache has been described as dull and/or pressure-like sensation, and throbbing and/or pulsating sensation. The pain is usually on both sides of the head (in 88%–93% of people with NDPH), but may be unilateral, and may be localized to any head region.[5] The pain can fluctuate in intensity and duration, is daily, and lasts more than 3 months.
There may be accompanying photophobia, photophobia, lightheadedness or mild nausea. Co-morbidity with mood disorders has been reported in a subset of patients.
Cranial autonomic nervous symptoms occur with painful exacerbations in 21%, and cutaneous allodynia may be present in 26%.[6]
In 2002, Li and Rozen[1] conducted a study of 56 patients at the Jefferson Headache Center in Philadelphia and published the following results:
· 82% of patients were able to pinpoint the exact day their headache started.
· 30% of the patients, the onset of the headache occurred in correlation with an infection or flu-like illness.
· 38% of the patients had a prior personal history of headache.
· 29% of the patients had a family history of headache.
· 66% reported photophobia.
· 61% reported phonophobia.
· 55% reported lightheadedness.
Imaging and laboratory testing were unremarkable except for an unusually high number of patients who tested positive for a past Epstein-Barr virus infection.
Although NPDH is classified as a primary headache syndrome, it must be remembered that a number of important conditions can present with a new-onset persisting headache, and these must be excluded prior to making a diagnosis of a primary headache disorder.
The diagnosis is one of excluding the many secondary types or NDPH mimics, which is especially critical early in the course of the disease when a secondary etiology is more likely. NDPH mimics include but are not limited to:
· subarachnoid hemorrhage
· idiopathic intracranial hypertension
· chronic subdural hematoma
· post-traumatic headaches
· spontaneous cerebrospinal fluid leak
· cervical artery dissections
· pseudo tumor cerebri without papilledema
· cerebral venous thrombosis
· NDPH with medication overuse headache
Many doctors state that the condition is best viewed as a syndrome rather than a diagnosis.[7] Once a diagnosis of NDPH is made, clinicians argue that patients are best managed according to the more detailed pathophysiology-based diagnosis than lumped together into a single group, since a single disorder is unlikely to exist.
NDPH It is classified as a Primary Headache Disorder by the ICHD-2 classification system (by the IHS) using number 4.8. It is one of the types of primary headache syndromes that present as a chronic daily headache, which is a headache present for more than 15 days a month for more than 3 months.
The ICHD Diagnostic Criteria is:[8]
1. Headache that, within 3 days of onset, fulfils criteria B-D
2. Headache is present daily, and is unremitting, for > 3 months
3. At least two of the following pain characteristics:
2. pressing/tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as walking or climbing
4. Both of the following:
1. no more than one of photophobia, phonophobia or mild nausea
2. neither moderate or severe nausea nor vomiting
5. Not attributed to another disorder
1. Headache may be unremitting from the moment of onset or very rapidly build up to continuous and unremitting pain. Such onset or rapid development must be clearly recalled and unambiguously described by the patient. Otherwise it is coded as 2.3 Chronic tension-type headache.
2. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12 (including 8.2 medication overuse headaches and its sub forms), or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.
Although the original Silberstein–Lipton criteria and the original description by Vanast make no suggestion for the exclusion of migrainous features in NDPH, the current ICHD criteria exclude patients with migrainous features. When migraine features are present, classification thus becomes problematic.
It has been reported that migraine symptoms may be present in over 50% of NDPH patients.[9] The current criteria definition thus excludes more than half of patients with new onset of daily headache. This exclusion due to migrainous features could have adverse scientific, diagnostic, and treatment consequences.[10]
One proposal for reclassification of the criteria is from a study conducted on retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of the Department of Neurology of Santa Casa de São Paulo, Brazil, and would be the following subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning.[11]
Another proposed reclassification of the criteria is from a study conducted as a retrospective chart review of patients seen at the Headache Center at Montefiore Medical Center in Bronx, New York, from September 2005 to April 2009. The revised criteria for NDPH definition does not exclude migraine features (NDPH-R), and three subdivisions were created and described based on prognosis: Persisting, remitting, and relapsing–remitting. Additionally, this revised criteria would not include parts C or D currently required by the ICHD diagnostic criteria for NDPH.[6]
The pathophysiology of NDPH is poorly understood. Research points to an immune-mediated, inflammatory process. Cervical joint hypermobility and defective internal jugular venous drainage have also been suggested as causes.[12][13]
In 1987, Vanast first suggested autoimmune disorder with a persistent viral trigger for CDH (now referred to as NDPH).[14] Post-infectious origins have been approximated to make up anywhere between 30-80% of NDPH patients in different studies. Viruses that have been implicated include Barr virus, Herpes simplex virus and cytomegalovirus.[15][16]
Non-specific upper respiratory infections including rhinitis and pharyngitis are most often cited by patients.[17] In one study, 46.5% patients recalled a specific trigger with a respiratory tract illness being the most common. In children, almost half report headache onset during an infection.
A study by Rozen and Swindan in 2007 found elevated levels of tumor necrosis factor alpha, a proinflammatory cytokine, in the cerebrospinal fluid but not the blood of patients with NDPH, chronic migraine, and post-traumatic headaches suggesting inflammation as the cause of the headaches.[18]
NDPH as an inflammatory, post-infectious manifestation indicates a potentialmeningoencephalitis event in NDPH patients. Tissue specificity is a general feature of post-infectious, immune-mediated conditions, and the meningesare a type of connective tissue membrane. Inflammation of the meninges was first proposed as a possible pathophysiology for migraine in the 1960s and has recently been explored again.[19] This hypothesis is based on meningeal mast activation. Reactive arthritis (ReA) is a post-infectious disease entity of synovium/joints with connective tissue membrane (synovial membrane of the joints) which provides a corollary.
NDPH has been reported in Hashimoto's encephalopathy, an immune-mediated type of encephalitis.[20] A mean 5-year retrospective analysis of 53 patients with a history of viral meningitis and 17 patients with a history of bacterial meningitis showed an increased onset of subsequent new onset headache and increased severity of those with prior primary headaches.[21]
As outlined by the ICHD, NDPH may take either of two sub forms: a self-limiting sub form which typically resolves without therapy within several months and a refractory sub form which is resistant to aggressive treatment programmes.
A number of medications have been used including: amitriptyline, propranolol, and topiramate.[22] There are no prospective placebo controlled trials of preventive treatment. In those with migrainous features treatment may be similar to migraines.[23]
Occipital nerve block have been anecdotally reported to be helpful for some patients with NDPH. 23/71 people had undergone a nerve block for their severe headache. The NDPH-ICHD group responded to the nerve block much more often (88.9%) than the NDPH with migraine features (42.9% responded to nerve block).[5]
Opiates, or narcotics, tend to be avoided because of their side effects, including the development of medication overuse headaches and potential for dependency. NDPH is often associated with medication overuse.[2] To avoid the development of medication overuse headaches, it is advised not to use pain relievers for more than nine days a month.
NDPH, like other primary headaches, has been linked to comorbid psychiatric conditions, mainly mood and anxiety and panic disorders. The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients presenting with psychiatric symptoms. Simultaneous treatment of both disorders may lead to good outcomes.[24]
Early history is a key to diagnosing NDPH. Evaluations to exclude secondary causes are necessary but usually negative.
Most patients have persistent headaches, although about 15% will remit, and 8% will have a relapsing-remitting type.[9] It is not infrequent for NDPH to be an intractable headache disorder that is unresponsive to standard headache therapies.
NDPH is difficult to treat and requires a multimodal approach. Questions regarding NDPH remain unanswered. Additional prospective studies are necessary to further understand, characterize, diagnose, and treat NDPH.
1. ^ Jump up to:a b c Li, D; Rozen, TD (2002). "The clinical characteristics of new daily persistent headache". Cephalalgia 22 (1): 66–9. doi:10.1046/j.1468-2982.2002.00326.x. PMID 11993616.
2. ^ Jump up to:a b Grande, RB; Aaseth, K; Lundqvist, C; Russell, MB (2009). "Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headache". Cephalalgia 29 (11): 1149–55.doi:10.1111/j.1468-2982.2009.01842.x. PMID 19830882.
3. Jump up^ Vanast, WJ (1986). "New daily persistent headaches: definition of a benign syndrome". Headache 26: 317.
4. Jump up^ Silberstein, Stephen D.; Lipton, Richard B.; Solomon, Seymour; Mathew, Ninan T. (1994). "Classification of Daily and Near-Daily Headaches: Proposed Revisions to the IHS Criteria". Headache: the Journal of Head and Face Pain 34 (1): 1–7. doi:10.1111/j.1526-4610.1994.hed3401001.x.PMID 8132434.
5. ^ Jump up to:a b Karceski, S. C. (2010). "Daily headache: What have we learned?”.Neurology 74 (17): e73–5. doi:10.1212/WNL.0b013e3181dbe0c3.PMID 20421575.
6. ^ Jump up to:a b Robbins, M. S.; Grosberg, B. M.; Napchan, U.; Crystal, S. C.; Lipton, R. B. (2010). "Clinical and prognostic sub forms of new daily-persistent headache". Neurology 74 (17): 1358–64.doi:10.1212/WNL.0b013e3181dad5de. PMC 3462554.PMID 20421580.
7. Jump up^ Goadsby, Peter J. (2011). "New Daily Persistent Headache: A Syndrome Not a Discrete Disorder". Headache: the Journal of Head and Face Pain 51(4): 650–3. doi:10.1111/j.1526-4610.2011.01872.x. PMID 21457252.
8. Jump up^ http://ihs-classification.org/en/02_klassifikation/02_teil1/04.08.00_other.html[full citation needed]
9. ^ Jump up to:a b Evans, Randolph W. (2012). "New Daily Persistent Headache”.Headache: the Journal of Head and Face Pain 52: 40–4. doi:10.1111/j.1526-4610.2012.02135.x. PMID 22540206.
10. Jump up^ Young, William B. (2010). "New Daily Persistent Headache: Controversy in the Diagnostic Criteria". Current Pain and Headache Reports 15 (1): 47–50.doi:10.1007/s11916-010-0160-4. PMID 21116742.
11. Jump up^ Monzillo, Paulo Hélio; Nemoto, Patrícia Homsi (2011). "Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?". Arquivos de Neuro-Psiquiatria 69 (6): 928–31. doi:10.1590/S0004-282X2011000700016. PMID 22297882.
12. Jump up^ Rozen, TD; Roth, JM; Denenberg, N (2006). "Cervical spine joint hypermobility: A possible predisposing factor for new daily persistent headache". Cephalalgia 26 (10): 1182–5. doi:10.1111/j.1468-2982.2006.01187.x. PMID 16961783.
13. Jump up^ Donnet, A.; Metellus, P.; Levrier, O.; Mekkaoui, C.; Fuentes, S.; Dufour, H.; Conrath, J.; Grisoli, F. (2008). "Endovascular treatment of idiopathic intracranial hypertension: Clinical and radiologic outcome of 10 consecutive patients". Neurology 70 (8): 641–7.doi:10.1212/01.wnl.0000299894.30700.d2. PMID 18285539.
14. Jump up^ Vanast, W.J.; Diaz-Mitoma, F.; Tyrrell, D.L.J. (1987). "Hypothesis: Chronic Benign Daily Headache is an Immune Disorder with a Viral Trigger”. Headache: the Journal of Head and Face Pain 27 (3): 138–42.doi:10.1111/j.1526-4610.1987.hed2703138.x. PMID 3036747.
15. Jump up^ Diaz-Mitoma, Francisco; Vanast, Walterj.; Tyrrell, Davidl.J. (1987). "Increased Frequency of Epstein-Barr Virus Excretion in Patients with New Daily Persistent Headaches". The Lancet 329 (8530): 411–5.doi:10.1016/S0140-6736(87)90119-X. PMID 2880216.
16. Jump up^ Meineri, P.; Torre, E.; Rota, E.; Grasso, E. (2004). "New daily persistent headache: Clinical and serological characteristics in a retrospective study".Neurological Sciences 25: S281–2. doi:10.1007/s10072-004-0310-8.PMID 15549561.
17. Jump up^ Prakash, Sanjay; Patel, Niyati; Golwala, Purva; Patell, Rushad (2011)."Post-infectious headache: A reactive headache?". The Journal of Headache and Pain 12 (4): 467–73. doi:10.1007/s10194-011-0346-0.PMC 3139051. PMID 21544648.
18. Jump up^ Rozen, Todd; Swidan, Sahar Z. (2007). "Elevation of CSF Tumor Necrosis Factor α Levels in New Daily Persistent Headache and Treatment Refractory Chronic Migraine". Headache: the Journal of Head and Face Pain 47 (7): 1050–5. doi:10.1111/j.1526-4610.2006.00722.x. PMID 17635596.
19. Jump up^ Levy, Dan (2009). "Migraine pain, meningeal inflammation, and mast cells". Current Pain and Headache Reports 13 (3): 237–40.doi:10.1007/s11916-009-0040-y. PMID 19457286.
20. Jump up^ Jacome, Daniel. "New Daily Persistent Headache As A Presenting Symptom Of Hashimoto's Encephalopathy". Webmed Central. Retrieved 22 December 2012.
21. Jump up^ Neufeld, Miriam Y.; Treves, Therese A.; Chistik, Vladimir; Korczyn, Amos D. (1999). "Post meningitis Headache". Headache: the Journal of Head and Face Pain 39 (2): 132. doi:10.1046/j.1526-4610.1999.3902132.x.
22. Jump up^ Mack, KJ (February 2009). "New daily persistent headache in children and adults.". Current pain and headache reports 13 (1): 47–51.PMID 19126371.
23. Jump up^ Tyagi, Alok (2012). "New daily persistent headache". Annals of Indian Academy of Neurology 15 (5): 62–5. doi:10.4103/0972-2327.100011.
24. Jump up^ Peres, M. F.; Lucchetti, G.; Mercante, J. P.; Young, W. B. (2010). "New daily persistent headache and panic disorder". Cephalalgia 31 (2): 250–3.doi:10.1177/0333102410383588. PMID 20851838.
· Evans, Randolph W.; Seifert, Tad D. (2011). "The Challenge of New Daily Persistent Headache". Headache: the Journal of Head and Face Pain 51: 145. doi:10.1111/j.1526-4610.2010.01812.x.
· Robert, Teri (2004). "New Daily Persistent Headache - The Basics". Health Central. )
sympathy or anything. What I do want… I am hoping that I can find someone to do research, because not much has been about NDPH. I have found a group, which has become a great source of help. I have created a questionnaire for all of us, because what research has been done, it is such a small group. I have compiled all the information, the similarities and differences. All the medications everything I possibly can.
In my lifetime, I just want to help one person if I can. That is what I am trying to do, I will be happy if I can just help one person.
Well that is it in a nutshell, what I have been going through for over 4 years. God bless each of you and remember every day is a blessing!!!