New daily persistent headache

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New daily persistent headache
Specialty Neurology

New daily persistent headache (NDPH) is a 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), usually in a person who does not have a history of a primary headache disorder. The pain can be intermittent, but lasts more than 3 months. Headache onset is abrupt and people often remember the date, circumstance and, occasionally, the time of headache onset. One retrospective study stated that over 80% of patients could state the exact date their headache began. [1]

Contents

The cause of NDPH is unknown, and it may have more than one etiology. NDPH onset is commonly associated with 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 syndrome is difficult to treat and may persist for years. 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.

Signs and symptoms

The headaches can vary greatly in their clinical presentation and duration.[ citation needed ]

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.[ citation needed ]

There may be accompanying photophobia, phonophobia, lightheadedness or mild nausea. Co-morbidity with mood disorders has been reported in a subset of patients.[ citation needed ]

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:

Imaging and laboratory testing were unremarkable except for an unusually high number of patients who tested positive for a past Epstein-Barr virus infection. [7]

Diagnosis

Although NDPH 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.[ citation needed ]

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:[ citation needed ]

Many doctors state that the condition is best viewed as a syndrome rather than a diagnosis. [8] 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.[ citation needed ]

NDPH 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.[ citation needed ]

ICHD criteria

The ICHD diagnostic criteria are: [9]

  1. Headache that, within 3 days of onset, fulfils criteria 2-4
  2. Headache is present daily, and is unremitting, for > 3 months
  3. At least two of the following pain characteristics:
    1. bilateral location
    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

Notes:

  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 subforms), 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.

Criteria revision

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. [10] 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. [11]

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. [12]

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]

Pathophysiology

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. [13] [14]

In 1987, Vanast first suggested autoimmune disorder with a persistent viral trigger for CDH (now referred to as NDPH). [15] Post-infectious origins have been approximated to make up anywhere between 30 and 80% of NDPH patients in different studies. Viruses that have been implicated include Epstein-Barr virus, herpes simplex virus, Covid19/SARS-CoV-2, and cytomegalovirus. [16] [17] [18]

Non-specific upper respiratory infections including rhinitis and pharyngitis are most often cited by patients. [19] 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. [20]

NDPH as an inflammatory, post-infectious manifestation indicates a potential meningoencephalitis event in NDPH patients. Tissue specificity is a general feature of post-infectious, immune-mediated conditions, and the meninges are 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. [21] This hypothesis is based on meningeal mast cell 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. [22] 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. [23]

Treatment

There is no specific treatment for NDPH. [24] Often they are treated similar to migraines. [24]

A number of medications have been used including amitriptyline, gabapentin, pregabalin, propranolol, and topiramate. [25] [26] There are no prospective placebo controlled trials of preventive treatment. In those with migrainous features treatment may be similar to migraines. [27]

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. [28]

Medications within the tetracycline family, mexiletine, corticosteroids and nerve blocks are being studied. [24] Occipital nerve block have been reported to be helpful for some people. 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]

Prognosis

Most patients have persistent headaches, although about 15% will remit, and 8% will have a relapsing-remitting type. [10] It is not infrequent for NDPH to be an intractable headache disorder that is unresponsive to standard headache therapies.

Related Research Articles

<span class="mw-page-title-main">Migraine</span> Disorder resulting in recurrent moderate-severe headaches

Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include nausea, vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation of headache symptoms during physical activity is another distinguishing feature. Up to one-third of migraine sufferers experience aura: a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks, consisting of as little as several lifetime attacks, to chronic disease.

<span class="mw-page-title-main">Headache</span> Pain in the head, neck, or face

Headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.

<span class="mw-page-title-main">Cluster headache</span> Neurological disorder

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s). There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.

<span class="mw-page-title-main">Tension headache</span> Medical condition

Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain usually radiates from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

A medication overuse headache (MOH), also known as a rebound headache, usually occurs when painkillers are taken frequently to relieve headaches. These cases are often referred to as painkiller headaches. Rebound headaches frequently occur daily, can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraine or tension-type headache that "transforms" over time from an episodic condition to chronic daily headache due to excessive intake of acute headache relief medications. MOH is a serious, disabling and well-characterized disorder, which represents a worldwide problem and is now considered the third-most prevalent type of headache. The proportion of patients in the population with Chronic Daily Headache (CDH) who overuse acute medications ranges from 18% to 33%. The prevalence of medication overuse headache (MOH) varies depending on the population studied and diagnostic criteria used. However, it is estimated that MOH affects approximately 1-2% of the general population, but its relative frequency is much higher in secondary and tertiary care.

<span class="mw-page-title-main">Triptan</span> Class of pharmaceutical drugs

Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first commercially introduced in the 1990s. While effective at treating individual headaches, they do not provide preventive treatment and are not considered a cure. They are not effective for the treatment of tension–type headache, except in persons who also experience migraines. Triptans do not relieve other kinds of pain.

Chronic paroxysmal hemicrania (CPH) is a severe debilitating unilateral headache usually affecting the area around the eye. It normally consists of multiple severe, yet short, headache attacks affecting only one side of the cranium. It is more commonly diagnosed in women than in men, but, unlike a migraine, has no neurological symptoms associated with it. CPH headaches are treated through the use of non-steroidal anti-inflammatory drugs, with indomethacin found to be usually effective in eliminating symptoms.

<span class="mw-page-title-main">Butalbital</span> Barbiturate drug used for headaches

Butalbital is a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as paracetamol (acetaminophen) or aspirin, for the treatment of pain and headache. The various formulations combined with codeine are FDA-approved for the treatment of tension headaches. Butalbital has the same chemical formula as talbutal but a different structure—one that presents as 5-allyl-5-isobutylbarbituric acid.

Sexual headache is a type of headache that occurs in the skull and neck during sexual activity, including masturbation or orgasm. These headaches are usually benign, but occasionally are caused by intracranial hemorrhage and cerebral infarction, especially if the pain is sudden and severe. They may be caused by general exertion, sexual excitement, or contraction of the neck and facial muscles. Most cases can be successfully treated with medication.

Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented. Hemicrania continua is considered a primary headache disorder, meaning that another condition does not cause it.

Persistent aura without infarction (PAWOI) is a rare and seemingly benign condition, first described in case reports in 1982 as "prolonged/persistent migraine aura status", and in 2000 as "migraine aura status", that is not yet fully understood. PAWOI is said to possibly be a factor involved in a variety of neurological symptoms, including visual snow, loss of vision, increased afterimages, tinnitus, and others. The pathogenesis of PAWOI is unknown. It is not clear which medical examinations are useful in diagnosing PAWOI. At present, PAWOI is usually diagnosed solely based on the patient's current and past symptoms. It is possible that an "overactive brain" or a chemical imbalance underlies the disorder. Various medications have been tried as treatment, notably acetazolamide, valproate, lamotrigine, topiramate, and furosemide.

Vestibular migraine (VM) is vertigo with migraine, either as a symptom of migraine or as a related neurological disorder.

The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders (ICHD). The current version, the ICHD-3 beta, was published in 2013.

<span class="mw-page-title-main">Red ear syndrome</span> Medical condition

Red ear syndrome (RES) is a rare disorder of unknown etiology which was originally described in 1994. The defining symptom of red ear syndrome is redness of one or both external ears, accompanied by a burning sensation. A variety of treatments have been tried with limited success.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing is a rare headache disorder that belongs to the group of headaches called trigeminal autonomic cephalalgia (TACs). Symptoms include excruciating burning, stabbing, or electrical headaches mainly near the eye and typically these sensations are only on one side of the body. The headache attacks are typically accompanied by cranial autonomic signs that are unique to SUNCT. Each attack can last from five seconds to six minutes and may occur up to 200 times daily.

Abdominal migraine(AM) is a functional disorder that usually manifests in childhood and adolescence, without a clear pathologic mechanism or biochemical irregularity. Children frequently experience sporadic episodes of excruciating central abdominal pain accompanied by migrainous symptoms like nausea, vomiting, severe headaches, and general pallor. Abdominal migraine can be diagnosed based off clinical criteria and the exclusion of other disorders.

Migraine treatment may be either prophylactic (preventive) or abortive (rescue). Prevention is better than cure, so the ideal treatment goal is to prevent migraine attacks. Because migraine is an exceedingly complex condition, there are various preventive treatments which have their effect by disrupting different links in the chain of events that occur during a migraine attack. As rescue treatments also target and disrupt different processes occurring during migraine, these are summarized, with their relative merits and demerits.

A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.

Neck-tongue syndrome (NTS), which was first recorded in 1980, is a rare disorder characterized by neck pain with or without tingling and numbness of the tongue on the same side as the neck pain. Sharp lateral movement of the head triggers the pain, usually lasting from a few seconds to a few minutes. Headaches may occur with the onset of NTS. The typical age of onset is around adolescence and may occur as early as 8–15 years old. However, it is worth noting that clinical onset can occur earlier or later and NTS onset related to trauma can occur at any age, beginning after the incident.

<span class="mw-page-title-main">Recurrent painful ophthalmoplegic neuropathy</span> Medical condition

Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is a rare neurological disorder that is characterized by repeated headache attacks and reversible ipsilateral paresis of one or more ocular cranial nerves (CN). Oculomotor nerve (CNIII) is by far the most common cranial nerve involves in RPON, while abducens nerve (CNVI) and trochlear nerve (CNIV) involvements are also reported. Globally, RPON was estimated to have an annual incidence rate of 0.7 per million as of 1990, no further epidemiological studies have been conducted. It occurs more often in children and females.

References

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  2. 1 2 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. S2CID   24240448.
  3. ↑ Vanast, WJ (1986). "New daily persistent headaches: definition of a benign syndrome". Headache. 26: 317. doi:10.1111/j.1526-4610.1986.t01-1-.x. S2CID   221751811.
  4. ↑ 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. S2CID   43292571.
  5. 1 2 Karceski, S. C. (2010). "Daily headache: What have we learned?". Neurology. 74 (17): e73–5. doi: 10.1212/WNL.0b013e3181dbe0c3 . PMID   20421575.
  6. 1 2 Robbins, M. S.; Grosberg, B. M.; Napchan, U.; Crystal, S. C.; Lipton, R. B. (2010). "Clinical and prognostic subforms of new daily-persistent headache". Neurology. 74 (17): 1358–64. doi:10.1212/WNL.0b013e3181dad5de. PMC   3462554 . PMID   20421580.
  7. ↑ Diaz-Mitoma, F.; Vanast, W. J.; Tyrrell, D. L. (1987). "Increased frequency of Epstein-Barr virus excretion in patients with new daily persistent headaches". Lancet. 329 (8530): 411–415. doi:10.1016/s0140-6736(87)90119-x. PMID   2880216.
  8. ↑ 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. S2CID   23180896.
  9. ↑ http://ihs-classification.org/en/02_klassifikation/02_teil1/04.08.00_other.html%5B%5D
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  11. ↑ 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. S2CID   37391834.
  12. ↑ 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.
  13. ↑ 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. S2CID   25434393.
  14. ↑ 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. S2CID   30729677.
  15. ↑ 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. S2CID   937845.
  16. ↑ 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. S2CID   35406435.
  17. ↑ 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. S2CID   33561625.
  18. ↑ Torrente, Angelo; Alonge, Paolo; Di Stefano, Vincenzo; Baschi, Roberta; Ornello, Raffaele; Correnti, Edvige; Lupica, Antonino; Camarda, Cecilia; Farinella, Gabriella; Raieli, Vincenzo; Sacco, Simona; Monastero, Roberto; Brighina, Filippo (2023-03-15). "New-onset headache following COVID-19: An Italian multicentre case series". Journal of the Neurological Sciences. 446: 120591. doi:10.1016/j.jns.2023.120591. ISSN   0022-510X. PMC   9931424 . PMID   36807975.
  19. ↑ 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.
  20. ↑ 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. S2CID   24890908.
  21. ↑ 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. S2CID   21309926.
  22. ↑ Jacome, Daniel (13 October 2010). "New Daily Persistent Headache As A Presenting Symptom Of Hashimoto's Encephalopathy". Webmed Central. Retrieved 22 December 2012.
  23. ↑ Neufeld, Miriam Y.; Treves, Therese A.; Chistik, Vladimir; Korczyn, Amos D. (1999). "Postmeningitis Headache". Headache: The Journal of Head and Face Pain. 39 (2): 132–134. doi:10.1046/j.1526-4610.1999.3902132.x. PMID   15613206. S2CID   45280694.
  24. 1 2 3 Rozen, TD (July 2014). "New daily persistent headache: an update". Current Pain and Headache Reports. 18 (7): 431. doi:10.1007/s11916-014-0431-6. PMID   24820732. S2CID   40617119.
  25. ↑ Mack, KJ (February 2009). "New daily persistent headache in children and adults". Current Pain and Headache Reports. 13 (1): 47–51. doi:10.1007/s11916-009-0010-4. PMID   19126371. S2CID   41412372.
  26. ↑ Evans, Randolph W.; Seifert, Tad D. (2011). "The Challenge of New Daily Persistent Headache". Headache: The Journal of Head and Face Pain. 51 (1): 145–154. doi: 10.1111/j.1526-4610.2010.01812.x . PMID   21198576.
  27. ↑ Tyagi, Alok (2012). "New daily persistent headache". Annals of Indian Academy of Neurology. 15 (5): 62–5. doi: 10.4103/0972-2327.100011 . PMC   3444222 . PMID   23024565.
  28. ↑ 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. S2CID   24820588.
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