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  1. Peter J Goadsby,
  2. Christopher Boes*
  1. Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to:
 Professor Peter J Goadsby, Institute of Neurology, Queen Square, London WC1N 3BG, UK;

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Chronic daily headache, defined as headache on 15 days or more per month for more than three months, is covered generally in another section of this supplement. However, because the syndrome of “new daily persistent headache” (NDPH) is so clinically distinct (table 1), and has an interesting range of secondary possibilities that are curable, we have elected to highlight the problem here. This is not to imply any linked pathophysiology but simply to highlight what is a clinically useful concept. From a nosological point of view most of what is covered here could be placed in the various parts of the classification system of the International Headache Society.1 It serves both patients and clinicians to highlight this syndrome because the implications of missing the diagnosis can be so profound. NDPH can have both primary2 and secondary forms (table 2). More general texts address the many surrounding issues of headache diagnosis and management.3,4

View this table:
Table 1

Proposed diagnostic criteria for new daily persistent headache

View this table:
Table 2

Differential diagnosis of new daily persistent headache


The patient with NDPH presents with a history of headache on most if not all days that began from one day to the next. The onset of headache is abrupt, often moment-to-moment, but at least in less than a few days (where three is suggested as an upper limit).4 The classical history, if that term is yet appropriate, will be for the patient to recall the exact day and circumstances, so from one moment to the next a headache develops that never leaves them. This presentation triggers certain key questions about the onset and behaviour of the pain. These need to be woven with the more generic questions that one asks a patient with persistent headache, to form a provisional diagnosis. The pressing issues arise from considering the …

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  • * Current address: Mayo Clinic Department of Neurology, Rochester, Minnesota, USA