This “trigger event” can vary for each person, but may include a fall, stressful life event, infection, or head or neck irritation.
The cause of NDPH is currently unknown. However, researchers have speculated that, like many chronic headache conditions, NDPH is a kind of “light switch headache,” meaning that several different chronic factors such as stress, inflammation, and abnormal neurological signals may occur over a long period of time, and once they reach a certain threshold, a “trigger event” can cause the headache to start. This “trigger event” can vary for each person, but may include a fall, stressful life event, infection, or head or neck irritation. Over 50% of people with NDPH are unable to determine a trigger event, and their headache may be due to the accumulation of several factors over time .
Helpful Articles on Causes of NDPH
The Three T’s of NDPH
By: Todd D. Rozen, MD, FAAN
New Daily Persistent Headache
By: Todd D. Rozen, MD, FAAN
Dealing with your NDPH
Involves exploring potential causes or triggers that may contribute to your pain. It is also possible that no specific cause may be found. Potential causes of NDPH include:
About 30% of NDPH cases are reported to arise after a viral infection. Several viruses have been implicated in potentially causing NDPH, presumably because of high levels of pro-inflammatory cytokines. Although NDPH patients do not usually show signs of active infection, they may have chronically elevated titers that indicate a past infection. These viruses include:
- Epstein-Barr (EBV)
- Viral sinus infection
- Herpes zoster
Stressful life event
In a 2014 study, about 10% of participants reported that their NDPH was triggered after a stressful life event, such as death of a friend or family member, relationship issues, moving, or job loss. Similarly to a viral infection, it is theorized that a stressful life event could lead to persistent central nervous system inflammation as a result of glial activation and increased cytokine levels. A 2006 study of 20 NDPH patients found that 19 out of 20 had elevated tumor necrosis factor alpha (TNFα) levels, which is a pro-inflammatory cytokine involved in brain immune activities and inflammation.
Dental or medical procedures
About 12% of people developed NDPH after a medical or dental procedure, according to a 2002 study. These participants tended to be older than the typical age range for NDPH and have underlying neck/cervical facet irritation. When their necks are positioned and hyperextended for intubation under anesthesia, this leads to over-activation of the trigeminocervical complex, irritating the nerves and causing a persistent headache.
Another presumed cause of NDPH is cervical hypermobility, where the joints and ligaments in the neck and upper spine are looser than normal. These patients tend to be tall and thin with a long neck, and show excess cervical spine range of motion on exam. In a 2005 study, 11 out of 12 NDPH patients were found to have cervical spine hypermobility (where the neck can cross the plane of the shoulder), and 10 of 12 had widespread joint hypermobility, as assessed through the Beighton score. Individuals with Ehlers-Danlos syndrome or other connective tissue disorders may develop NDPH as a result of this cervical hypermobility.
Since NDPH is more accurately classified as a syndrome than a diagnosis, a myriad of causes has been found. Here are some of the more unusual, often isolated reports of NDPH/persistent headache causes:
- Bone spurs in the shoulder
- Nutcracker syndrome (see here and here)
- May Thurner Syndrome (MT)
- Craniocervical instability (CCI)
- CSF issues (IIH, spinal fluid leak, normal pressure hydrocephalus)
- Reversible cerebral vasoconstriction syndrome (RCVS)
- Post-treatment Lyme disease
- Celiac disease
- Low B12
- Tapering off of an SSRI
- Post-HPV vaccination or other vaccinations
- Unremitting head & neck pain (UHNP)/nerve compression
- Neuralgia/occipital neuralgia/trigeminal neuralgia
Click here to go to the Diagnosis page under “NDPH Mimics” to learn about other conditions that can mimic NDPH.
 Rozen, T. D. (2019). The three T’s of NDPH (how clinical observations have led to improved treatment outcomes). Headache: The Journal of Head and Face Pain, 59(8), 1401-1406.