Clinical and prognostic subforms of new daily-persistent headache

Area of Science:

• Neurology
• Headache Medicine

Background:

• Current International Classification of Headache Disorders (ICHD)-2 criteria for new daily-persistent headache (NDPH) exclude cases with migraine features.
• This exclusion presents a classification challenge for primary daily headaches unremitting from onset when migraine features are present.

Purpose of the Study:

• To develop and validate a revised definition of new daily-persistent headache (NDPH-R) that incorporates migraine features.
• To compare clinical and demographic characteristics of patients classified under the revised definition versus existing criteria.

Main Methods:

• A revised NDPH definition (NDPH-R) was developed, not excluding migraine features.
• The NDPH-R definition was applied to patients at Montefiore Headache Center.
• Patients were divided into NDPH-ICHD-2 and NDPH-mf groups for comparative analysis of features and prognosis.

Main Results:

• Of 71 NDPH-R patients, 43.7% met NDPH-ICHD-2 criteria; the remainder had too many migraine features (NDPH-mf).
• NDPH-mf patients were younger, had more women, and higher depression rates than NDPH-ICHD-2.
• Both groups showed similar allodynia, triptan response, and overall prognosis, with distinct subgroups (persisting, remitting, relapsing-remitting).

Conclusions:

• The ICHD-2 criteria inadequately classify most patients with primary daily persistent headaches.
• The proposed NDPH-R definition creates a clinically and prognostically homogeneous group.
• NDPH-R criteria warrant consideration for inclusion in the upcoming ICHD-3, improving headache classification.