Prevalence of New Daily Persistent Headache in the General Population. The Akershus Study of Chronic Headache

Abstract

The aim of the present study was to investigate the prevalence of new daily persistent headache (NDPH) in the general population, and compare the clinical characteristics of NDPH and chronic tension-type headache (CTTH). This is a population-based cross-sectional study. A random sample of 30 000 persons aged 30-44 years was drawn from the population of Akershus County, Norway. A postal questionnaire was screened for chronic headache. Those (n = 633) with self-reported chronic headache within the last month and/or year were invited to an interview and examination by a neurological resident. A follow-up interview was conducted after 1.5-3 years. The headaches were diagnosed according to the International Classification of Headache Disorders, 2nd edn and relevant revisions. The response rate of the questionnaire was 71% and the participation rate of the interview was 74%. Four persons, three men and one woman, had NDPH. The overall 1-year prevalence of NDPH was 0.03%. The clinical characteristics of NDPH and CTTH were similar, except for the sudden onset in DPH.Three of the four persons with NDPH had medication overuse. Follow-up disclosed that the symptomatology of NDPH is not unchangeable, since two persons had improvement of their NDPH. NDPH is rare and occurs in one of 3500 persons from the general population of 30-44-year-olds. It is often associated with medication overuse.

New Daily–Persistent Headache Versus Tension-type Headache

“…In this study, the population prevalence of CTTH was 2.2%, which is similar to the prevalence in other major CTTH reports [12]. A more recent study undertaken in Norway used the more restrictive ICHD-II criteria [2], documenting an NDPH prevalence of 0.03%, compared to a CTTH prevalence of 1.3% [13].…”

“…Patients from North America, Europe, and Asia have been identified with NDPH, including Caucasian, AfricanAmerican, Hispanic, and Asian individuals [3, 5•, 6••, 7••, 13,16,18,19], but no racial predilection has been reported yet. African-American individuals may have a lower prevalence of CTTH than Caucasians [12].…”

Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?

“…Only two recent studies reported a higher incidence of NDPH in men. This predominance in women is still not well explained in the literature 1,6,7,11 . The women presented the initial headache prematurely in relation to the men, data which is in line with the literature 6 .…”

“…The etiology remains unknown 6 , although some authors have tried to establish a temporal relationship to infectious conditions, especially to the Epstein-Barr virus (EBV) [7][8][9] . The purpose of our work is to describe the clinical characteristics of the daily persistent headache presented by our patients and to correlate them with the criteria established by the IHS-2004.…”

New Daily Persistent Headache: Controversy in the Diagnostic Criteria

“…In one recent population-based epidemiological study, NDPH occurred in 0.1% of patients [3]. Other estimates are that NDPH makes up 1.7% to 10.8% of chronic daily headache [4].…”