New daily persistent headache: should migrainous features be incorporated?

Cephalalgia. 2011 Nov;31(15):1561-9. doi: 10.1177/0333102411424620. Epub 2011 Sep 29.


Introduction: International Classification of Headache Disorders (ICHD-2) criteria for new daily persistent headache (NDPH) require tension-type headache features. Many patients with 'new-onset persistent' headache fail to fulfil such criteria due to prominent migrainous features.

Subjects and methods: We reviewed all NDPH patients in our headache clinic, using the definition of persistent headache < 3 days after onset for > 3 months. The patients were dichotomised: patients meeting ICHD-2 criteria (NDPH-S) and patients failing to meet ICHD-2 criteria due to prominent migrainous features (NDPH-M). All patients had completed a structured intake form including demographics, headache profiles, Beck Depression Inventory (BDI), Short Form 36 (SF-36) Health Survey, and Migraine Disability Assessment (MIDAS). A telephone interview was conducted for follow-up.

Results: A total of 92 NDPH patients were enrolled (59 (64.1%) NDPH-M, 33 (35.9%) NDPH-S). Between the two subgroups, the sociodemographics were indistinguishable, but the patients with NDPH-M had higher headache intensity, BDI scores, MIDAS scores, and lower scores of most SF-36 subscales. After an average of 2 years of follow-up, 57 (66%) had a good outcome (≥ 50% reduction in headache frequency). Cox proportional analysis showed that disease duration ≤ 6 months and NDPH-S diagnosis predicted good outcomes.

Conclusion: Migrainous features were common in patients with NDPH. Unlike prior studies, our study showed NDPH-M represented a more severe subgroup with a poorer outcome compared with NDPH-S.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Female
  • Headache Disorders / diagnosis*
  • Headache Disorders / epidemiology
  • Headache Disorders / therapy*
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / diagnosis*
  • Migraine Disorders / epidemiology
  • Migraine Disorders / therapy*
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Taiwan / epidemiology
  • Terminology as Topic*
  • Treatment Outcome
  • Young Adult