The New Daily Persistent Headache (NDPH) is daily from its onset and usually peaks in about three days. Most patients can pinpoint exactly when it began to a day or an hour. Many patients remember many specifics of the day as well. These NDP Headaches seem to respond exceedingly well to Sphenopalatine Ganglion Blocks.
Unlike most headache patients, patients suffering from New Daily Persistent Headache rarely have any headache history. It is very important to rule out any serious underlying causes prior to initiating any treatment!
The symptoms described can mimic migraine or tension-type headache or a mixture of both types. Long term NDPH can match descriptions of chronic migraine or chronic tension headaches.
NDPH can be one of two types, those that resolve spontaneously over a period of several months and also a refractory subtype that seems resistant to aggressive treatment regimens.
The refractory subtype can have features of either intractable migraine or intractable tension-type headache. Like almost all headaches NDPH is a Trigeminal Nerve Headache probably involving both somatosensory nerves and autonomic nerves.
The current rationale for the use of Sphenopalatine Ganglion Blocks (SPG) in treating New Daily Persistent Headache is to treat symptoms not to prevent recurrence. The use of SPG Blocks every two weeks may effectively reduce symptoms over time.
The use of Self Administered SPG Blocks on a twice daily basis initially and tapering down to once daily, than twice weekly and then weekly or even once or twice a month is a better approach for most patients. Self-Administered Treatment with SPG Blocks may be directed toward elimination of the problem and not just treatment of symptoms.
The effectiveness of the SPG Blocks for both Tension-Type Headaches and for Migraines make them a natural choice for New Daily Persistent Headaches.
Initially it offers quick pain relief and the repeated administration before rebound allows the system to reset itself. Ideally starting treatment before the headache has been present for three months may eliminate the headaches before 3 months making NDPH a poor diagnosis.
The goal is to return the patient to their presymptomatic status as quickly as possible. There is no specific cause for onset but it can be considered that the Homeostatic balance has been lost thereby initiating and maintaining the headache without clear underlying pathology.
Sphenopalatine Ganglion Blocks act as a reset mechanism for Homeostasis in the system. When a computer quits working correctly we reset it by hitting Control /Alt /Delete to rest it. The effect of the SPG Block is similar and resets Homeostasis. If we utilize aggressive medication protocols we risk permanently upsetting the homeostatic balance and medication may actually be what causes a self-limiting sub-type to become a refractory sub-type NDPH. Avoiding iatrogenic conversion from sub-type 1 to sub-type 2 is essential and great care should be taken in patients with sudden onset new headaches.
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