4.10 New daily persistent headache (NDPH)

Previously used terms:

Chronic headache with acute onset; de novo chronic headache.


Persistent headache, daily from its onset, which is clearly remembered. The pain lacks characteristic features, and may be migraine-like or tension-type-like, or have elements of both.

Diagnostic criteria:
  1. Persistent headache fulfilling criteria B and C
  2. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours
  3. Present for >3 months
  4. Not better accounted for by another ICHD-3 diagnosis1;2;3;4.
  1. 4.10 New daily persistent headache is unique in that headache is daily from onset, and very soon unremitting, typically occurring in individuals without a prior headache history. Patients with this disorder invariably recall and can accurately describe such an onset; if they cannot do so, another diagnosis should be made. Nevertheless, patients with prior headache (1. Migraine or 2. Tension-type headache) are not excluded from this diagnosis, but they should not describe increasing headache frequency prior to its onset. Similarly, patients with prior headache should not describe exacerbation associated with or followed by medication overuse.
  2. 4.10 New daily persistent headache may have features suggestive of either 1. Migraine or 2. Tension-type headache. Even though criteria for 1.3 Chronic migraine and/or 2.3 Chronic tension-type headache may also be fulfilled, the default diagnosis is 4.10 New daily persistent headache whenever the criteria for this disorder are met. In contrast, when the criteria for both 4.10 New daily persistent headache and 3.4 Hemicrania continua are met, then the latter is the default diagnosis.
  3. Abortive drug use may exceed the limits defined as causative of 8.2 Medication-overuse headache. In such cases, the diagnosis of 4.10 New daily persistent headache cannot be made unless the onset of daily headache clearly predates the medication overuse. When this is so, both diagnoses, 4.10 New daily persistent headache and 8.2 Medication-overuse headache, should be given.
  4. In all cases, other secondary headaches such as 5.1 Acute headache attributed to traumatic injury to the head, 7.1 Headache attributed to increased cerebrospinal fluid pressure and 7.2 Headache attributed to low cerebrospinal fluid pressure should be ruled out by appropriate investigations.

4.10 New daily persistent headache has two subtypes: a self-limiting subtype that typically resolves within several months without therapy, and a refractory subtype that is resistant to aggressive treatment regimens. These are not separately coded.