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4.8New daily-persistent headache (NDPH) G44.2  
Previously used terms De novo chronic headache; chronic headache with acute onset


Headache that is daily and unremitting from very soon after onset (within 3 days at most). The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity. There may be photophobia, phonophobia or mild nausea.

Diagnostic criteria:

  1. Headache that, within 3 days of onset1, fulfils criteria B-D
  2. Headache is present daily, and is unremitting, for >3 months
  3. At least two of the following pain characteristics:
    1. bilateral location
    2. pressing/tightening (non-pulsating) quality
    3. mild or moderate intensity
    4. not aggravated by routine physical activity such as walking or climbing
  4. Both of the following:
    1. no more than one of photophobia, phonophobia or mild nausea
    2. neither moderate or severe nausea nor vomiting
  5. Not attributed to another disorder2


  1. Headache may be unremitting from the moment of onset or very rapidly build up to continuous and unremitting pain. Such onset or rapid development must be clearly recalled and unambiguously described by the patient. Otherwise code as 2.3 Chronic tension-type headache.
  2. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12 (including 8.2 Medication-overuse headache and its subforms), or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.


This second edition of the classification recognises 4.8 New daily-persistent headache as a separate entity from 2.3 Chronic tension-type headache. Although it has many similarities to tension-type headache, NDPH is unique in that headache is daily and unremitting from or almost from the moment of onset, typically in individuals without a prior headache history. A clear recall of such an onset is necessary for the diagnosis of 4.8 New daily-persistent headache.

The headache of NDPH can have associated features suggestive of either migraine or tension-type headache. Secondary headaches such as low CSF volume headache, raised CSF pressure headache, post-traumatic headache and headache attributed to infection (particularly viral) should be ruled out by appropriate investigations.

If there is or has been within the last 2 months medication overuse fulfilling criterion B for any of the subforms of 8.2 Medication-overuse headache, the rule is to code for any pre-existing primary headache plus 8.2.8 Probable medication-overuse headache but not for 4.8 New daily-persistent headache.

NDPH may take either of two subforms: a self-limiting subform which typically resolves without therapy within several months and a refractory subform which is resistant to aggressive treatment programmes. The subcommittee aims to stimulate further clinical characterisation and pathophysiological research of this syndrome, especially studies comparing 4.8 New daily-persistent headache with 2.3 Chronic tension-type headache.