Retrospective Characterization and Review of 466 New Daily Persistent Headache Cases Within a Quaternary Healthcare System

BackgroundNew Daily Persistent Headache (NDPH) is an enigmatic syndrome characterized by a distinct onset headache that becomes continuous and unremitting within 24 hours and persists for at least 3 months without underlying structural cause. Patients may experience years or decades of pain with negative impacts on functionality and quality of life. Although characteristically treatment resistant, case reports of response to pharmacologic therapies exist, though with great heterogeneity and without generalizability. Given NDPH is incompletely characterized and displays phenotypic variability, it is possible that better sub-population identification might yield more targeted therapeutic directions. MethodsWe conducted a retrospective chart review of adult patients seen within the University of Pittsburgh Medical Center System who received an NDPH International Classification of Diseases 9 or 10 code between 2011-2019. 5,926 patient charts were reviewed and only those who satisfied International Classification of Headache Disorders, 3rd edition criterion were further analyzed. Two independent data collectors reviewed each chart. Results466 individuals satisfied NDPH diagnostic criteria. Median age at first consultation was 37.1 years, with 66.7% of the population identifying as female. Length of NDPH duration at the last consultation was 1.75 years. Headache onset exhibited no obvious seasonality. Headaches were unilateral in 12.5% of cases and severe pain was reported in 79.1% of cases with documented pain severity. Thunderclap onset was observed in 5.8% of cases. Further categorization into migraine (MP) and tension (TP) phenotypes found approximately even distribution, 207 and 214 respectively. Both MP and TP exhibited demographics, precipitating factors, and prognostic types reflective of the general population. In comparison to TP, MP patients described increased prevalence of severe pain (48.3% vs 14.0%), nausea (68.6% vs 33.6%), vomiting (25.1% vs 7.0%), light-sensitivity (85% vs 27.1%), noise-sensitivity (80.7% vs 24.8%), and osmophobia (19.3% vs 3.7%). Comparison of MP and TP exacerbating factors found increased reporting of physical activity (23.7% vs 10.3%). Chronicity of MP and TP found similar breakdowns with 26.1% vs 23.4% reporting 5+ years of headache. ConclusionsNDPH is a refractory, severe pain headache disorder that exhibits no seasonality for onset, with equal breakdown of MP and TP subtypes.