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Question
Posted by: Dan | 2011-11-01

New Persistent Daily Headache

Hi

I have been diagnosed with New Persistent Daily Headache (NPDH), a headache form that does not seem to respond to any treatment, including vasoconstrictors, amitryptaline, and epilim chrono (depokate). The pain is quite featureless, with no aura or nausea. It is generally located in the occipital region. After ten months of unremitting pain, my neurologist has told me that nothing can be done for NPDH. It is hard to cope with a diagnosis like this. Does anyone know of success with NPDH treatments as opposed to ''regular'' migraine? Thank you.

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Our expert says:
Expert ImageHeadache expert

Dear Dan,

If your neurologist cannot help you then it indicates that the problem is unlikely to be a neurological one. The fact that your headache has been given a name is also of no benefit, as it doesn’t give any indication of the origin of the pain. Pain ALWAYS comes from some anatomical structure. To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on http://www.headacheclinic.co.za/

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

3
Our users say:
Posted by: Dr E Shevel | 2011-11-03

Dear Dan,

It just means that the doctors you have seen have not yet been able to find the source of the pain - even if you have been to see many of them. If you wish to endure the pain however without covering all your bases, then that is your prerogative.

Reply to Dr E Shevel
Posted by: Dan | 2011-11-02

Thank you for your response.

I have seen neurologists, physiotherapists, and oro-facial pain doctors. I have also had various MRIs. No anatomical structure has been found to cause the pain, though the physiotherapist did find some abnormal tension in the neck region. Manipulation and physical therapy had no effect.

NPDH headache, unlike migraine, will not respond to any triptans or preventers. The pain is unremitting. This diagnosis is very hard to accept for an otherwise healthy man with no prior medical complaints. In any case, thank you for responding.

Dan

Reply to Dan
Posted by: Headache expert | 2011-11-02

Dear Dan,

If your neurologist cannot help you then it indicates that the problem is unlikely to be a neurological one. The fact that your headache has been given a name is also of no benefit, as it doesn’t give any indication of the origin of the pain. Pain ALWAYS comes from some anatomical structure. To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on http://www.headacheclinic.co.za/

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